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Carnage in America: Introduction

I’m a doctor. Sixty-two years old. Three grown children.

After medical school graduation and an internship in Kentucky, I flew to Honolulu (tough duty, I know) for my residency training. The city has a sizable gay population, and I learned how to care for patients with AIDS.

In 1988, when I moved back to my home town of Eau Claire, Wis., word got out that I had an interest in AIDS. My patients, all men, either were gay or had hemophilia. They suffered from unusual infections in their brains, eyes, or lungs. Typically, the infections were treatable, but the virus wasn’t; drug cocktails that changed AIDS from a death sentence to a chronic disease didn’t arrive until the mid-90s. The young men, in that pre-drug era, wasted away mentally and physically. Often abandoned by their families, they died alone.

Clinically devastating and unique biologically, AIDS also became political. Even as HIV was killing them, gay men fought for effective treatment.

A Republican president wasn’t listening. He refused to give the virus due respect. Not until autumn of 1985 did Ronald Reagan publicly discuss AIDS. Perhaps he was heeding religious conservatives who called AIDS a gay curse, God’s just and deserved punishment.

I’m haunted by plagues.

So when word came of a contagion in China, in a city named Wuhan, my brain went on high alert. Soon after, I sat in a Maui conference room attending an internal medicine update, where the first doctor’s topic was new developments in infectious disease.

“I had to tweak my talk a bit,” he said. “Figured I should share something regarding this virus we’ve all been hearing about.”

There were ripples of laughter across the room.

By mid-February, it was clear to me that virus-wrought mayhem would only get worse. I read all things COVID, to which my wife can attest. On March 22, sensing that 2020 would be momentous, I started a daily diary. Ten days later, my son Erik, a tech-savvy millennial, turned my chronicle into the blog that became this book.

Heroism amidst tragedy. Missed opportunities and breathtaking incompetence. Heartache leavened with moments of joy.

I’ll be your tour guide, but the journey is ours. Americans each of us, we’ve endured it together.

Pandemics, Power, and Snake Oil

The first century Roman emperor Nero, who became ruler at age 16, was a disreputable dude. His mother tried to rule by proxy through her son. Five years into his reign, he staged a shipwreck in which she was drowned.

Nero divorced his first wife, Claudia, when he impregnated his girlfriend Poppaea, who he married 12 days after the divorce. During Poppaea’s next pregnancy, Nero killed her in a fit of rage by stomping on her abdomen. Statilia, who was married to another man, was Nero’s mistress. After the murder, Statilia’s husband was forced to commit suicide so she could marry the emperor. Later that year, Nero also married a boy named Sporus and had him castrated. He forced Sporus to appear in public as his wife, dressed in the regalia of Roman empresses.

When an epidemic of bubonic plague killed thousands of Romans, Nero ordered his chief physician to circulate an old miracle cure. “It was an attempt by Nero to sustain his legitimacy in the midst of this catastrophic event,” said Aaron Shakow, a medical historian at Harvard, who added, “Epidemics are dangerous to rulers.”

This year, in early March, a group of French scientists launched an experiment to see if the 85-year-old drug hydroxychloroquine could be the miracle cure for COVID that everyone sought. Before the study was published online, a lawyer falsely claiming an affiliation with Stanford University appeared on Fox News’ Tucker Carlson Tonight to tout the results: a “100 percent cure rate against coronavirus.” The next day POTUS was hailing the drug as a “game changer” and “a gift from God.” The only problem? The study’s results failed to match the hype.

The gold standard for a clinical study is the double-blind trial, in which neither patients nor researchers know which treatment is given—placebo or active drug. Patients are randomized into two groups, the baseline characteristics of each made as equivalent as possible.

But in the French study, the treatment and control (placebo) groups came from different populations, the former from the researchers’ Marseille hospital and the latter from other facilities in the south of France. Moreover, the study was “open label,” meaning both patients and researchers knew which treatment was being administered. The study included just 42 patients, three of whom were transferred to the ICU, a fourth died, one stopped treatment because of nausea, while a sixth left the hospital and was lost to follow up.

If you’d only heard about the “100 percent cure rate” promoted on Fox News, you’d assume the four patients with worse clinical outcomes (three ICU transfers and one death) had been unlucky enough not to receive the “cure.” But all four patients, and the two others cited above, were given hydroxychloroquine.

The six patients were excluded from analysis because of how the researchers reported the results: whether or not COVID was present in nasal swab specimens obtained on each day of the study. (Why specimens weren’t taken from ICU patients isn’t clear.) Based on the swabs of the 36 analyzable patients, the ones receiving hydroxychloroquine cleared COVID from their noses a bit faster than those who didn’t.

In summary, an experiment in which 15 percent of the treatment group and no one in the control group had poor clinical outcomes was reported as having a “100 percent cure rate.” On April 3, two weeks after the study’s publication online, the International Society of Antimicrobial Chemotherapy—itself an obscure organization—publishers of the French study, said the group’s board “believes the article does not meet the Society’s expected standards.”

Didier Raoult, the lead author of the French study, and Harold Bornstein, POTUS’s former physician, who’d said that POTUS’s “physical strength and stamina are extraordinary” and that POTUS, “if elected, will be the healthiest individual ever elected to the presidency”—bear a striking resemblance. Though probably a coincidence, perhaps POTUS takes a shine to docs with a certain look. Central casting!

Rather than admitting his mistake, Tucker Carlson and his Fox co-conspirators, in typical POTUS fashion, doubled down. “It’s probably the most shameful thing I, as someone who has done this for 20 years, has ever seen,” Carlson proclaimed last week. “It’s making a lot of us ashamed to work in the same profession as those people. So reckless and wrong in the middle of a pandemic, it really is, for real.”

The objects of his scorn? “Members of the media” who’ve criticized POTUS for promoting hydroxychloroquine. Sean Hannity is also mad, hornet-like. (From the movie Bombshell: “If it pisses off your grandfather and scares your grandmother, it’s a Fox News story.”) The drug is showing signs of success, Hannity said, “in spite of what the mob and the media is telling you.”

The manufactured controversy about the efficacy of hydroxychloroquine is the most recent variation on Fox’s theme of conjuring new culture wars like rabbits from a magician’s hat. The strategy works.

In 2005, Bill O’Reilly introduced America to the “War on Christmas,” which he opined was being waged from within. At the time, a Gallup poll showed 41percent of respondents preferred “Happy Holidays” and 56 percent “Merry Christmas.” At the end of each year, as the country became more religiously diverse, the network revisited the non-issue. A decade later, only 25 percent preferred “Happy Holidays,” while 65 percent chose “Merry Christmas.”

On Fox, the enemies conceived (POTUS’s lifeblood) are often elites portrayed as opposing that which the loyal viewership knows to be righteous and true. On her program April 9, Laura Ingraham said, “After hearing all of the stories where hydroxychloroquine is credited with saving lives, it is amazing that the left and the medical establishment is still in total denial about the potential of these decades-old drugs.”

Earlier, Fox weekend host Jesse Watters denounced the “cherry-picking snakes, liars and backstabbing hypocrites” who’ve prevented patients from receiving hydroxychloroquine. “The president was hopeful but was savagely attacked in the media,” he said. As an example, he played a clip of Rachel Maddow calling POTUS’s hype “cruel and harmful…and wildly irresponsible from anyone in a leadership role,” which sounds accurate to me.

According to Dan Cassino, a political scientist and author of Fox News and American Politics: How One Channel Shapes American Politics and Society, “Even if there’s not a lot of disagreement in the medical community about the use of hydroxychloroquine, the fact that you can point to people on both sides means that any opinion is justified.”

Voila, controversy.

Rupert Murdoch’s misinformation machine isn’t limited to Fox News. What was Jerry Hall thinking? I used to think she was cool! Murdoch’s Wall Street Journal has jumped on the hydroxychloroquine bandwagon, cheerleading the drug in two recent editorials.

People who’ve studied POTUS’s tweets say that the more outrageous, the more demonstrably false, the more frequently re-tweeted are the Conman-in-chief’s missives. Counterintuitive though it seems, P.T. Barnum understood.

Before and after the 2016 election, I asked dozens of patients their political opinions. Every POTUS supporter watched Fox, and none solicited my perspective. (Maybe the majority already knew.)

In the field of psychology, the Dunning-Kruger effect is a cognitive bias in which people with low aptitude at a given task overestimate their ability. My personal take is Dunning and Kruger were half right. No one’s immune to inappropriate cockiness. Like COVID, the tendency doesn’t discriminate, based on IQ or anything else; according to a classic study, more than 90 percent of college professors thought themselves “above average.”

Isaac Asimov may have said it best. “There is a cult of ignorance in the United States, and there always has been. The strain of anti-intellectualism has been a constant thread winding its way through our political and cultural life, nurtured by the false notion that democracy means that my ignorance is just as good as your knowledge.”

So it’s no surprise that at Anthony Fauci, POTUS is pissed.

Harold Bornstein - Right

Didier Raoult - Left

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