Fever Swamps and Conspiracy Theories

I am going to write today about something I thought I would never see in my career – all 30 years of it.  We are witnessing the complete fractious political polarization of our populace with regard to not only a worldwide airborne pandemic, but more importantly our response to it as a nation.  As more and more people are falling ill or dying, the worse the division seems to become.  It has truly been an amazing and revealing four months.

As a physician, my primary job is the education of my patients.  This has been a very difficult job indeed with very high levels of disinformation swirling around our culture.

We have the usual fever swamp of the Internet and all the conspiracy theories that entails.

We have one side of cable news with folks like Rachel Maddow, perfecting her scaremongering techniques as the nights go on.  Spending hours counting down deaths with a gleam in her eye, the constant chyron of destruction ever changing before our eyes as we demand death counts updated to the second.

On the other side of cable news are people like Sean Hannity, demanding that we all treat this crisis as the big nothingburger that it is.  Minimizing the risk and danger.  Demanding the demasking of America.  Egging on people to buck the health experts.

And through it all, we have social media like Facebook where the hostility is palpably increasing by the day.  I have personally witnessed friends and family members fileting each other over an open fire with hate and vitriol.  I have attempted on multiple occasions to inform, educate and be a referee only to have the vitriol aimed at myself and my innocent wife.  

If you look at this cultural situation rationally through the stages of grief, I believe we all can agree we have left the initial denial phase.  Some of us are now stuck in anger – showing up with weapons in State Capitol buildings, and some of us are stuck in bargaining – begging the gods of science to bring us a vaccine or antivirals, willing to pay any price. Actual acceptance seems to be light years away.  Will we ever arrive?

This divide applies to almost every aspect of this crisis – the value of the lockdowns, the testing, the masking or lack thereof, even recently extending to the actual mortality numbers themselves.   Perhaps, there is no other issue that most exemplifies this chasm than the drug hydroxycholorquine (Plaquenil).

As a general internist, I have three decades of using this agent in multiple dozens of patients, possibly hundreds.  The vast majority of these patients have been little old ladies with rheumatoid arthritis.  I have a deep and abiding respect for its ability to alleviate their pain.  But I also have a deep respect for its ability to cause mayhem.  I have never had a mortality of even morbidity from this drug, but it must be monitored aggressively.  I assume most internists have a very similar experience.

Amazingly, this pharmaceutical drug is now viewed as either a toxic drug from hell or a rational reasonable therapy for this disease.  It all depends on whether you are red or blue.  I cannot think of another time in American history when a pharmaceutical agent has been politicized like this.

I thought the political insanity around this agent had peaked early in the crisis when Michigan Governor Gretchen Whitmer announced that there would be licensing issues if any physician in her state prescribed it for COVID.   Of course, her advisers quickly realized that this stance was absolutely against federal drug prescribing laws and also there were state Medical Board issues in question.  They realized that lawsuits by the hundreds would soon be coming from all sides and so that directive was dropped like the hot potato that it was.

However, the worse was yet to come.  It waited until this week to arrive when the President announced that he was taking Plaquenil and had been doing so for some time.  The Plaquenil bomb has now gone off in our national press for the past 2 days.

I want to make it very clear, I am not a big fan of our President.  I think there have been multiple ways in which he could have handled this crisis much better.  However, I am not a fan of our Congress or our media either – and they have handled this whole affair in a contemptuously egregious fashion.

I was first assaulted with the wisdom of Speaker Pelosi yesterday – “I am very concerned the President may die, he is morbidly obese, and this drug is a very bad choice for him.”  Well, Dr. Pelosi, let me assure you that the President is NOT morbidly obese.  Morbidly obese patients are not able to play 18 holes of golf in 90 degree weather.  He has Class 2 or 3 obesity almost assuredly – but your words belie that you have absolutely no idea what you are talking about – but then again you are not a physician, are you?  Why do you think you are qualified to opine about such things?  On national television?

Up next was on Morning Joe on MSNBC this morning – Senator Chuck Schumer injected this into the debate – “All kinds of doctors and scientists are telling us this does not work and is a deadly poison.  This is irresponsible of the President to engage in this behavior.”  Well, Dr. Schumer, perhaps I should inform you that I have quite literally dozens of medical colleagues all over this nation who are taking this drug prophylactically, many of whom are in the trenches and on the front lines in your own state.  We know there are multiple people testing positive in the White House just this week – why should the President not avail himself of protection? He has clearly discussed this with his own doctor.  There is only one controlled clinical trial that I know of at this time, Dr. Schumer, and it was done with very ill patients already in the ICU.  All we have at this time as far as evidence for prophylaxis and early stage therapy are anecdotal reports, many of which are very encouraging.   I have an idea – why don’t you shut the blow hole about things that you have no idea what you are talking about?

But the best thing on Morning Joe today was the rant of Joe Scarborough.  He informed the nation that in his medical opinion, the President was a liar – he was not taking Plaquenil at all.  NOPE, just making it all up.  The President would never take the stuff – his own FDA has stated that this drug will kill you and his own VA has stated that it will never be used in one of their hospitals – that it had failed the initial trial.   Hmmm, Dr. Scarborough, you really are a liar.  Did you forget to mention to the American people this morning that the FDA has approved this drug FOR DECADES for use in rheumatoid arthritis, lupus and malaria patients?  Did you forget to quote a senior VA official, Robert Wilkie who stated – “This was an observational study, not a clinical study.  We know the drug is working well on middle-aged and younger veterans.  And the Governor of New York was just in the Oval Office yesterday asking for more.”?  No, Dr. Scarborough, the mouth is running but you have no idea what you are saying. 

The worst though came from an actual physician, Dr. Ralph Northam. Governor of Virginia.  He tweeted today – “And as the only medical doctor among our nation’s governors, I suggest you stop taking hydroxychloroquine.  Let’s all get back to work.”

Dr. Northam, it is academic physicians in critical care medicine at your own medical school in Virginia – EVMS – who have been among the leading proponents of the early use of Plaquenil in these patients.  They have even published a widely heralded protocol online for the world to see:

 https://www.evms.edu/media/evms_public/departments/internal_medicine/EVMS_Critical_Care_COVID-19_Protocol.pdf.  They even have the benefit of having smashing results to boot.  Maybe you should go have them give you a lecture.

Dr. Northam, when have you as a pediatric neurologist used Plaquenil for anything?  I, as an internist, would never deign to recommend seizure medications for a young child. Especially in any kind of national forum.   Why, oh why do you feel it necessary to spout off like this about something that is not even close to your field of expertise?  PSSST, Dr, Northam, this belittles you – maybe just as badly as your blackface episode last year.

My point is all these people above have verbalized for decades that the decision to perform an abortion is strictly between the patient and her physician.  They are 100% correct in that assertion.  Why then, all of a sudden, is a medical decision to take a drug deliberated between the patient, his physician, the Speaker of the House, Democrats in the House and Senate, blowhards on national political cable shows, and all the opinion pages of the national news?  The cognitive dissonance and hypocrisy are overwhelming.  All of the “medical” opinions from people who have no business saying a word is really causing much confusion and angst for the American people.  It needs to stop right away.

My mind takes me back to my year as an intern at Parkland in Dallas.  Right in the big middle of the AIDS pandemic then sweeping this nation.  I counted every death certificate I signed that year – 274 of them – and wrote out every name of the deceased.  I have kept that list all these years – and look at it often.   274 deaths is orders of magnitude higher than the death counts in many of our states so far in this COVID pandemic.  Thinking this way gives you some perspective.  Things have been much worse.

It also reminds me of all the toxic drugs – some of them not approved – that we were forced to use on these poor souls in an attempt to save their lives or alleviate their pain.  

What HIV intern never had to deal with FOSCARNET and the sudden hypocalcemia causing seizures and intensely painful muscle spasms?  With emaciated patients hallucinating and screaming from the pain?

What HIV intern never had to deal with PENTAMIDINE IV and the intense intractable hypoglycemia that happened – often taking your patient right away in the middle of the night?

What HIV intern never had to deal with TALC or BLEOMYCIN pleurodesis for effusions, causing your patient pain not experienced since a medieval torture chamber?

NO-SIR-EEE, we have never as a profession given anyone toxic meds in the chance to save their lives – NO -SIR -EEE.  That is what all the media and politicians would have our people believe today.  And it is a shameful lie.  It is one of the worst lies I have ever seen told to the American people – and it is a blot on our media.   It is being used as a club to pit one side against the other – exactly what we do not need in this time of crisis.

As a veteran of the AIDS pandemic, I can assure you that even though there were bumps along the way back then, our cultural landscape was in a much better place.  We did not have our cable news, social media, and Internet dissecting every medical fact, blowing up numbers, taking things out of context and totally confusing the American people.  We did not have politicians and talking heads on TV every day talking about medical information that they did not remotely understand.  We did not have constant death chyrons on TV every minute of the day.  We did not have people on both sides trying their best to politicize every single aspect of a horrible tragedy.

I for one would go back to the 1980s in a heart beat.

“The advanced societies of the future will not be governed by reason.  They will be driven by irrationality, by competing systems of psychopathology.”

JG Ballard

American Science Fiction Author

1930-2009

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Glenn Burnett II

Glenn E Burnett II MD is an internist in practice at St John’s Hospital in Jackson Hole WY. He did his Internal Medicine Residency at Parkland Hospital and UT Southwestern in Dallas. 

  7 comments for “Fever Swamps and Conspiracy Theories

  1. Cammy Benton MD
    May 23, 2020 at 2:57 pm

    I love this article. Bingo.

  2. Kurt
    May 21, 2020 at 5:18 pm

    Ummmm, Loved it. I’m thinking of the folks who take Plaquenil 1 week before safari to Africa, during the time they’re there and one week after. Don’t think that would be recommended if it was a “deadly poison”. (sic)

  3. Pat
    May 20, 2020 at 2:00 pm

    Excellent essay, well done.

    And this conflict exemplifies the worth of my personal motto: “When in doubt, choose freedom.”

    Neither politician, nor media yap, nor well-intentioned clinician, nor bullying government epidemiologist can possibly know what is good for each individual. My view is that this lockdown has been a needless catastrophe. Of course no one can prove it, as lockdown proponents will say it could’ve been much worse without crashing the economy and suspending civil liberties. This will be, should be, an intense debate for years to come. I will continue to argue that those at-risk populations should have self-quarantined, while others were free to pursue their lives, each making their own risk calculations.

    Before the Covid Clench, we spilled a lot of words here deriding the excesses of the AAFP and ABFM’s MOC for pushing “population health” on individual clinicians . What has this been now, but medicine enabling our worst societal voices to force their prescriptions on others?

  4. Cliff Norman
    May 20, 2020 at 1:57 pm

    Excellent post. Appreciate the clarity and unbiased delivery.

  5. Rando
    May 20, 2020 at 1:16 pm

    Great essay and it echoes my own thoughts. After the way the media has presented this, I actually went back and reviewed the literature on hydroxychloroquine thinking maybe I had missed something. Nope, it’s the same as always, Plaquenil is safe for the great majority of patients.

    Does it work for COVID-19? I don’t know but that doesn’t justify its rare side effects being greatly magnified. I have a relative who takes it and she wrote recently “how can it be safe for people with lupus and arthritis, but toxic to everyone else?” All this publicity is going to scare away patients that could greatly benefit from it. Why don’t these reporters take five minutes and talk to a rheumatologist?

    And sorry to get political but I should say in my opinion the way our president has handled this has been grossly irresponsible, especially his public statements. That is separate from whether Plaquenil is safe or not. His statements do not justify an equally irresponsible reaction from the media and his opponents.

    One other thing you touch on, when did it become required we treat patients only with FDA approved, clinical study-proven medications in the middle of a pandemic? I went through the early HIV years too and we did what we thought would give the patients their best shot. At first all you have is anecdotal evidence and small studies.

  6. Rusty Shackleford
    May 20, 2020 at 1:08 pm

    The Architect in charge of our Matrix is high AF.

  7. Benjamin Van Raalte
    May 20, 2020 at 12:52 pm

    Another political difference between AIDS epidemic and COVID. Now we are told to hunker down no matter what the price, that life is sacred, even one death, even if the economy collapses. We are told to avoid all elective procedures in COVID patients.
    But with HIV patients back when there was limited treatment , any avoidance even for elective, non medically essential procedures was discriminatory, even at the risk of the staff and physicians.
    No numbers exist but we lost a lot of our colleagues to hepatitis B and HIV that was acquired at work.

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