Public Health Failure meets Rules Based Medicine Failure

Once upon a time, Public Health kept the water safe and enforced quarantine for highly contagious diseases. Physicians were highly educated, judgmental and organizationally disciplined.

Since the HIV epidemic, liberal planing introduced two changes. 1. Liberals passed legislation forbidding routine testing for HIV and tightened the rules insuring patient’s medical confidentiality to the point of stiffening both continuity of care and medical education. 2. An overgrown medical bureaucracy introduced rules based medical care based on guidelines with disciplinary measures against physicians not following those guidelines. 

If nothing else, the CoV2 pandemic exposed these failures. Firstly, the inertia of Public Health in reacting to the pandemic lead to a faster and broader spread of the disease. Rules based guidelines became obsolete by the time they are published. Contact tracing and quarantine was overwhelmed. Secondly, guidelines denied the use of treatments not supported by as yet incomplete double blind studies. 

Universal rules forgo regional variability and the magic of multiple trial and error, an end of the scientific method. Medical bureaucracy insisted on a negative interpretation of the relevance and validity of many published clinical trials, not completed and interpreted by themselves. These acronymous agencies, CDC, FDA, NIH, HHS and a plethora of others placed greater value on population wide studies, statistics and completion of years long studies. The inertia of time alone rendered their judgments irrelevant. This egregious denial of care from government entities resulted in many unnecessary deaths and continues to do so today. 

Traditionally, the consideration of multiple clinical trials and clinical judgment was the prerogative of individual clinicians viewing multiple variables. Any clinical physician knows that treatment is highly individual and enhanced by the presence of a trusted physician, and that most clinical studies contain a bias of one sort or another: independent variables, clinical bias, incompetence, statistical or just plain inertia. Then enters political bias. Hospital employers even licensing agencies got into the act threatening  consequences for any deviation from their negative guidelines.

The generations long history of treating Influenza included off label drugs with antiviral efficacy and support with multiple strategies including optimal treatment of underlying conditions and support of the immunize system. The same could apply to COVID19. With a death rate over 20% for patients over 70, physicians needed to be free to treat early and try options.

In the heat of the pandemic, with rigid guidelines, other serious conditions were neglected. Guidelines, algorithms and artificial intelligence fell far short of adequate management of the multiple problems and fast changing threats.