Liberal Types Need to Engage More Thoughtfully with Conspiratorial Thinking and Distrust

Distrust in medicine is understandable, especially given certain recent high-profile scandals.

It’s been a dark few months for news about American healthcare.

First, and most sexy for online discourse (literally and figuratively lol), a gunman who appears to have been acting alone, Luigi Mangione, killed a top health insurance CEO on a sidewalk in New York City, inspiring a lot of weird homicidal (and horny) discourse, which was kind of (awkwardly imo!) rationalized by the fact that everyone is furious about the state of American healthcare.

Secondly, and less sexily, the New York Times revealed that Perdue Pharma, through shady third-party intermediaries, was paying to keep prescription opioids flowing freely to pharmacies even at the height of the epidemic that was killing an astronomical number of Americans.

I really think, when it comes to discussing distrust in America, and with medicine in general, you can’t overstate how important the opioid epidemic was/is to American politics, the nation’s mood and well being, and maybe even Trump. (As with so many issues, we should care about opioids because of the huge harms. But we only care about that stuff because of Trump, which is sorta how we got Trump, imo.)

Opioids, this is an issue that has hit my state, Ohio, so so hard. My background is in traffic safety so that is my basis for comparison with everything. We kill HUGE numbers of people in the U.S. every year with cars. Just staggering. Last year it was around 43,000. Unlike a lot of other leading killers, the victims here are disproportionately young: in their teens and early 20s. It’s mind numbing frankly, and we have a weird aversion to thinking or talking about it which contributes, in my opinion, to the problem.

But during the pandemic, and around those years, opioid deaths DWARFED the number of people killed by cars. In 2020, we had 100,000 opioid deaths (primarily fentanyl) (more people died of overdoses in San Francisco during the height of the pandemic than covid, which killed primarily old people and make the numbers a bit awkward for direct comparison). Our death rate in Ohio for drug overdoses is 43/100,000. For comparison, the number of car crash deaths per 100,000 population in Ohio is 7.

Many, many kids I went to school with and grew up with have had their lives ruined by opioids. Apparently, the years my sister and I graduated, 2001 and 2003, as well as suburban Columbus, where we grew up, were sorta ground zero for this phenomenon, at least according to this book I read about it a while back.

I remember when I was in high school, these pills being around at parties I was at. My friends using them. We all thought it was really no big deal. They’re prescription, we thought, ie less bad than things like LSD.

Luckily I never tried it. And one time when I was a prescribed them after my wisdom teeth were removed, I didn’t even like them and didn’t finish the perscription. They made me itchy. I guess I just don’t have that addiction gene, which frankly is dumb luck imo.

But it’s funny looking back. We were always mocking these really hyperbolic “DARE, Say No to Drugs” campaigns. But glib dismissals were based on an outdated conception of drugs, from the 1970s. The reality actually ended up being a lot like what they warned — just horrible, horrible consequences.

We had no idea that these pills that were circulating were going to ruin so many people’s lives. Nobody warned us that the people pushing the drugs that might ruin your life, the people you needed to be skeptical of maybe, were doctors and pharmacies and big corporations (of course they were being supplied by kids who stole them out of medicine cabinets more commonly, but still). We couldn’t have imagined that at the time. They seemed to have this safety seal of approval, from trusted authorities, so in a way our assessment was to be expected and rational.

Life is unexpected like that sometimes though. Major risks aren’t always apparent at the time. Sometimes the official consensus is wrong — and that can be really disastrous. Sometimes powerful businesses or agencies act in ways that betray the public interest in profound ways, the way Perdue Pharma did when it paid middlemen called “Pharmacy Benefits Managers” not to restrict the flow of opioids as the scope and scale of the crisis started to become more apparent.

Who knows what kind of thing is going on right now that will be a similar scandal to opioids. Scientific understanding is always evolving. Just a few years ago, we were telling folks a glass of red wine with dinner is good for their heart. Now they’re walking that back, saying abstinence from alcohol is best for your health.

Honestly who knows how much the “beverage industry” contributed to that erroneous health advice and what they did to try to shaper recommendations. Due to some of my aforementioned public health research, I know that they are an important lobbying force in the U.S. and were instrumental in shaping drunk driving laws in a way that was perverse in my opinion.

Here’s another example really blows my mind: who would have predicted that baby powder, this was a universal household item when I was growing up, would be linked to terrible cancers? We all spent decades sprinkling it all over newborn babies’ bare butts. Nothing could have seemed more benign, or caring even and normal. Now Johnson and Johnson is under fire as it has been linked to ovarian cancer.

Distrust in science and medicine, recently, has become very politically right coded however. RFK is Trump’s nominee for Health and Human Services, and has been sort of an important and polarizing figure in all this. I don’t want to get into that too much, except that I think he and Trump’s remarks about vaccines I think have been harmful to public health. On the other hand, some of RFK’s stances aren’t as crazy as they sound. Leana Wen, for example, for the former head of Planned Parenthood and a respected scientist, defended his stance on fluoride, which was considered by a lot of people just too oddball to engage with.

Trump making offhand remarks for his enormous audience falsely connecting vaccines with autism is inexcusable, honestly. I’m honestly afraid measles is going to make a comeback in Ohio as a result of this - but also wider messaging failures and breaches of public trust.

I also think left-leaning people have not done themselves any favors in how they have handled this issue. They have been too strident, too unwilling to engage with any disagreement, or nuance, including that from qualified scientists.

It wasn’t that long ago, we considered the “lab leak theory” of covid that kind of oddball — dangerously misinformed! — thing to even consider. Although now, we now that we might never be able to rule out that the virus emerged from a (mismanaged?) scientific research lab in Wuhan, and that its a semi-likely possibility it did, at least according to some leading scientists and some U.S. government intelligence agencies.

Think of the implications of that for public trust. We spent the whole pandemic telling people — in my opinion, kind of patronizingly, to “trust science” — and then it turns out the source of the disease that killed more than 1 million people worldwide, may have been a scientific lab. That’s the kind of thing that really leaves a mark. And we’ve never fully contended with the way it was handled, in part for partisan reasons, imo. Which undermines public trust even further and fuels conspiratorial thinking with all kinds of wide ranging and disastrous consequences.

At times in the last few years, left-wing people have been able to acknowledge legitimate reasons for distrust in science and medicine, albeit in a limited way. For example, the Tuskegee Experiments were brought up as a legitimate reasons Black Americans might distrust medicine, refuse vaccines. But that was sort of the extent of it. If it weren’t for judges striking down vaccine mandates, Democrats in blue states and cities would have likely succeeded in having many of those distrustful Black Americans fired from federal jobs etc. which FWIW, I don’t think would have been too helpful in restoring trust.

Now, in their defense, or at least as an explanation, I think it’s pretty clear Democrats were trying to counter anti-vaccine pseudoscience, for legit reasons of course, but they got a little carried away and in the process made it worse. They were too dismissive of public concerns, too quick to scold and imperious, and that contributed to a loss of trust as well. When you look at the covid vaccination rate for American children, I think you can see how ineffective some of the messaging was.

Here’s the thing I think it’s important to acknowledge: Who hasn’t had an encounter with the American medical system that made them angry or offended? It is the most normal thing in the world. It is strange to see the side of the political aisle that handled vaccine distrust — which is legitimately frustrating — this way, then turn around and defend gunning down an insurance executive from the healthcare industry on the grounds that the system is hopelessly corrupt.

I’ve been lucky that I haven’t needed a ton of healthcare over the years, and the limited encounters that I’ve had — primarily uncomplicated childbirth in a hospital — were mostly positive. I don’t come from a culture that is particularly suspicious of medicine either. I’m college educated, etc. (Women’s gynecological care, in fairness, has been a tiny bit political fraught admittedly in my state and that has affected me minorly on a few occasions.)

But if I’m being honest, needles and that kind of thing, have always made me nervous. That is natural. Me and my kids are fully vaccinated. But even for someone like me, someone with private insurance, good health, not a lot of demographic factors that might negatively affect the way I’m treated, I still feel burned a lot of times by the interactions I do have with healthcare.