You and I both know that the house is haunted/Yeah you and I both know that the ghost is you/Used to walk around screaming, all slamming all 'dem doors
Well I'm all grown up now, I don't scare easy no more ~ Shakey Graves
Politics. How did fear become the most compelling instrument of U.S. policymaking? It is an especially interesting question for those who might have watched the end of the Alabama-Tennessee game on Saturday.
Despite constant warnings about all the things of which Americans need to be fearful – respiratory viruses, violence against marginalized people, terrorism and its fellow -isms – thousands of people flooded the field at Neyland stadium after an unexpected victory over Alabama.
Black, white, male, female, short, tall, thin and fat. Everyone was there, and they feared nothing, not even the $250k fine to be assessed this week for tearing down the goalposts.
(and, apparently dumping them in the Tennessee River.)
It was a moment of sheer joy, clarified, distilled and palpable for anyone who saw it – except Alabama fans, of course.
Is fear as a primary driver of policy – everything from airline safety to oil and gas extraction to cancer screening – reaching a similar end as the generation that engineered it?
It is no doubt a spent force as so much of what the academics insist is scary hardly ever comes up in conversation. The violence promised for those that give voice to important policy questions hardly ever happens. The vaccine defense against a respiratory virus that once promised apocalypse is now of little interest to anyone that does not subscribe to Mother Jones. A jury in Michigan concluded the FBI was a little too tight with its domestic terrorist friends for a conviction for attempted murder of Governor Gretchen Whitmer.
The only question to be answered now is, when do the people still hiding under their desks or at their dining room table office, finally join the joyful celebration on the field at Neyland Stadium? or anywhere else for that matter.
Policy. Policymaking without fear has its limits. Who would get a colorectal cancer screening colonoscopy unless you feared a deadly diagnosis?
For you people under 50, you will learn the answer is “no one.”
Of course, for all the marketing, colonoscopies do not really move the needle on the one thing that matters – all cause mortality. A paper published last week in the NEJM concluded that the risk of death from colorectal cancer declined for a screening population versus a usual care population. (.28% v. .31%). For all cause mortality, however, the two groups were nearly identical (11.03% v 11.04%).
Fear not, gastroenterologists. With the help of Katie Couric, you should make your boat payment.
Most people – that is most people with a reliable primary care physician – listen to their internist who recommends the screening and the GI. Those without a PCP relationship simply roll with the odds which is not, it turns out, all that stupid.
It is long past time for policymakers policy makers to identify people who are at greater than average risk for CRC – people with a family history and African American men. Unfortunately, that would require reconsideration of the screening age criteria.
It may also be that they don’t scare as easily.
Power: It is without irony that policymakers who rely on fear, very often have a solution at hand.
But, what if they don’t? Or more accurately for these times, what if their solution is actually worse than the scary thing itself?
Reasoned arguments won’t and don’t work.
Enter Twitter.
It appears that one way to limit debate on say, the safety and efficacy of Covid vaccines for low-risk populations like young men, is to talk Twitter into disappearing those that ask a few questions, or worse, demand some answers.
As lawsuits proceed in federal courts, the thuggery of Andy Slavitt – something with which health care people have long been familiar – and others, reveals itself.
Their less than charming behavior is now so well known, Joe Kernan felt compelled to ask Scott Gottlieb, a regular contributor to CNBC, about his efforts to ban former New York Times reporter, Alex Berenson, from Twitter.
Gottlieb’s response was to conjure up more scary. He claimed not to be concerned about Alex Berenson but about the violence that might erupt in response to Berenson’s full participation in social media debate.
Aside from making no sense - Berenson is over a year into pointing out holes in parts of the COVID story. What is important to consider is how little ammo must be in box, given the financial and reputational consequences if even part of Berenson’s conclusions is correct.
Have a great rest of your weekend.
Emily Evans
Managing Director – Health Policy
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