Novak Djokovic: Cancelled

I’ve defended both the idea of cancellation in the abstract, as well as specific cancellations, done in specific ways, on this blog. My critics have done an end-run around what I’ve actually said about cancellation, as well as the examples I’ve adduced, focusing on the unintended consequences of cancellation that lead, or supposedly lead, to “lynch mobs,” the “thought police,” and the like.*

I still have a great deal more to say about cancellation as both a philosophical and a historical matter, but in honor of one of the greatest cancelers in American history, Martin Luther King Jr (whose birthday is celebrated tomorrow), I’ve decided to descend to casuistry and inaugurate Cancel Week: a week of posts devoted to nothing but cancellations and anti-cancellations. (Sotto voce confession: I have a lot more than seven examples at my disposal, so this “week” may last awhile. But if revolutionism entails revisionism, revisionism about the meaning of “week” is to be expected.)

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Omicron, Delta, and the Revenge of Count von Count

I heard today from a physician whose hospital is on the verge of collapse, and an ICU nurse at a different hospital who is likely struggling with COVID, but being instructed not to get tested so as not to miss work. Two fairly typical stories from the edge of the healthcare abyss, but entirely predictable and a long time in the making. “Hospitals are understaffed” is now common knowledge, not a news story. The question is why. There’s no way to answer that question in the absence of information about staffing and budget decisions, themselves connected to facts about medical billing and collecting. This article is a case in point.

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Fatal Vision: Boosters, Variants, and Equity

Getting a booster is no panacea, but not getting one may be a fatal mistake. That, at any rate, is the finding of a set of Israeli studies in the New England Journal of Medicine, one published in October, the other published just a few days ago. An excerpt from the abstract of the “Conclusions” section of the latter:

Across the age groups studied, rates of confirmed Covid-19 and severe illness were substantially lower among participants who received a booster dose of the BNT162b2 vaccine than among those who did not.

Read both articles all the way through for all of the relevant provisos and qualifications, but I think it’s fair to summarize both by saying that they jointly found that boosters reduced the incidence of both serious morbidity and mortality due to COVID-19, inclusive of all variants but Omicron (about which it’s too early to tell). Continue reading

Hit Me with Your Best Shot

Well, it looks like the pro-booster side has essentially won the argument, at least in the US, over whether boosters ought to be given for recipients of the Pfizer-Biontech COVID vaccine, six+ months after the second dose. My brother Suleman and I have (very incompletely) argued the case in favor of boosters here, here, and here. As front-line health care workers (he’s a physician, I worked in OR EVS), we got our first doses of the shot back in December 2020, and our second ones in January 2021. He works with COVID patients in a hospital, and I work in an increasingly crowded office. Neither of us had any sense of how much protection we were getting from the vaccine at this point.

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New blogger: Suleman Khawaja

I wanted to welcome a new blogger to Policy of Truth, my brother, Suleman Khawaja. Suleman is currently a hospitalist at Valley Hospital in Ridgewood, New Jersey, where (in Ridgewood, not at Valley) he also runs a private practice as an expert witness on a variety of medico-legal issues. He received his BA in Political Science (minoring in Philosophy) at Duke University, and got his MD at the Pritzker School of Medicine at the University of Chicago. He did his residency in Internal Medicine at UNC Medical Center in Chapel Hill, North Carolina. By a strange coincidence, both Suleman and I studied extensively with Alasdair MacIntyre–as a graduate student at Notre Dame in my case, and as an undergraduate at Duke in his.

Suleman will be blogging here primarily on health care issues, with a particular focus on the COVID-19 pandemic.

Who Made WHO: COVID-19, Global Class Warfare, and Booster Shots

Who pick up the bill when who made who? Ain’t nobody told you?

–AC/DC

On August 18th, The New York Times ran a story on the front of its feed titled “Booster Shots ‘Make a Mockery of Vaccine Equity,’ the WHO’s Africa director says.” In case that statement sounds needlessly inflammatory and emotionally manipulative, here’s the actual quote from Dr. Matshidiso Moeti:

Moves by some countries globally to introduce booster shots threaten the promise of a brighter tomorrow for Africa. As some richer countries hoard vaccines, they make a mockery of vaccine equity.

To say that the introduction of a booster program in one nation poses a near-existential threat to a continent of 1.2 billion people is a stretch. But it’s not until you drill down to the factual details of the worldwide dynamic of COVID prevalence, vaccine production, and actual vaccination that you get a sense of how misleading and irresponsible that statement is, and how shaky is Moeti’s subsequent claim that as a consequence of boosters, more dangerous variants of COVID will arise.

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COVID Booster Shot Meets Health Care Monopoly

This post is part of an occasional series on health care. Here’s the prologue to the series, which originally preceded the post below.

Here’s a fairly straightforward story from The New York Times from a few days back, reminding us of the fact that immunity from some of the COVID vaccinations is limited in time, and may well require a booster shot.

 WASHINGTON — Biden administration health officials increasingly think that vulnerable populations will need booster shots even as research continues into how long the coronavirus vaccines remain effective.

Senior officials now say they expect that people who are 65 and older or who have  compromised immune systems will most likely need a third shot from Pfizer-BioNTech or Moderna, two vaccines based on the same technology that have been used to inoculate the vast majority of Americans thus far. That is a sharp shift from just a few weeks ago, when the administration said it thought there was not enough evidence to back boosters yet.

On Thursday, a key official at the Centers for Disease Control and Prevention said  the agency is exploring options to give patients with compromised immune   systems third doses even before regulators broaden the emergency use authorization for coronavirus vaccines, a step that could come soon for the Pfizer    vaccine.

Skipping a bit:

Pfizer’s continuing global study of its clinical trial participants shows that four to six months after the second dose, the vaccine’s effectiveness against symptomatic infection drops from a high of 95 percent to 84 percent, according to the company.

As a (then) full-time hospital worker actively exposed to high concentrations of COVID, I got my second dose of the Pfizer-BioNTech shot on January 6. If the vaccine’s effectiveness definitely drops from 95% to 84% in four to six months, then I’m well past my due date for a booster. Though I’m no longer a full-time hospital worker, I’ve been waiting for twelve weeks now for the paperwork to go through on my bid to work per diem for Hunterdon Medical Center’s OR. Assuming it goes through, I’ll be back in the COVID-intensive environment I previously inhabited. And if it doesn’t go through, I intend to apply to do the same work at a different hospital. So one way or another, I intend to make my way back to hospital work, and (by implication) to re-immerse myself in COVID.

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Health Care: A Series

This was originally a post on COVID booster shots, but I’ve now broken it into two separate posts, the first a prologue offering a very general summary of my approach to issues in health care, and the second, a post expressing skepticism about the need to wait any longer before we roll out a COVID booster, as well as skepticism about monopolistic institutional arrangements (distributive and/or regulatory) in health care.

I work in health care, but have no worked-out view on the political economy of health care. In fact, part of the reason I accepted the (full time) job I currently have, in hospital revenue cycle management, is to clarify my thoughts on that very subject. So I’m open to being schooled on issues in health care by anyone willing and able to do so–a category that probably includes a very large number of people. For the time being, I’m willing to remain at least temporarily in a state of curmudgeonly skepticism, willing to take pot shots at almost everyone, but unwilling to pledge allegiance to much of anything. You might regard that as a frivolous position to take, considering the stakes involved. But I don’t.

Since I’m going to be writing here at PoT about health care a fair bit in the near future (I’ve done some already), take what I say in the preceding skeptical (or dialectical) spirit. My aim is, through discussion and experience, to work my way from skepticism to something more definite.

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Hospitals Are Not Safe: Infection, PR, and EVS

I get the need (I suppose) to see the bright side of things as expressed in this article on LinkedIn, especially after the misery of the COVID-19 pandemic. Hospital workers did great things during the pandemic, and can be justifiably proud about the good they did. But I wish I had thirty minutes with a hospital executive at the level of Mikelle Moore below, to give them a small dose of some realities with which they seem oddly unacquainted.

Adapting to Uncertainty, Learning on the Front Lines and Creating a Purposeful New Normal | AHA News

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