I read Sally Satel's PC/MD over 20 years ago, during the height of political controversies affecting me professionally, and found her to be a breath of fresh air. She has a new piece at the American Enterprise Institute's publication Medicine in the Age of Social Justice.
One effort to dismantle racism was undertaken in late 2020 by the CDC’s Advisory Committee on Immunization Practices (ACIP). As you remember, at first, we had to ration the vaccine. It was clear that people over 65 were undeniably the highest-risk group for getting COVID morbidity and mortality. Almost every country gave them high priority. Yet ACIP told the CDC that it should not prioritize age. Why? Because, the 65-and-over cohort in America was whiter than the general population...
ACIP’s decision was anomalous. Racial politics is not an accepted method of rationing scarce treatment resources. Public health has used various other options, such as basing distribution on who has the best prognosis—that’s classic battlefield triage—or who is the sickest, or on a first-come, first-served basis. (That’s how kidneys are allocated when you need a transplant.)
Remarkably, ACIP did its own calculation and found that overall, more Americans would die, between 0.5 percent and 6.5 percent, if the equity approach were implemented. Older Black people would be among them.
Most of us would call "more people dying" a big deal in medicine. From personal experience I will tell you that doctors know a lot of bad sociology and believe it. It does influence some decisions.
2 comments:
Ironically, the effect of prioritizing black Americans probably had another negative effect. I saw a black comedian the other day who pointed out that, as soon as the government said "Black people will get this first," all his friends suddenly became extreme vax skeptics.
So I was a bit suspicious she was linking to YouTube and not the published standards since I knew those existed, and even more suspicious since I signed up my (white) in laws almost immediately (they were > 75), as they were some of the first people eligible.
My suspicions were justified. Those recommendations do not appear in the guidance we went forward with, which did stratify by age after vaccinating those in long term care facilities and front line healthcare workers: https://www.cdc.gov/mmwr/volumes/69/wr/mm695152e2.htm
There was state to state variation, and someone actually did a paper comparing how states implemented their own guidance: https://pmc.ncbi.nlm.nih.gov/articles/PMC8036633/?utm
Interestingly, the most common variation was that states had for the early rollout guidance was to ignore prioritizing those 75+ and instead opening it to those 65+ all at once.
I did watch part of the video and she correct this was part of the discussion at one point, a few months prior to vaccine approval. You can definitely criticize it being raised at all, but I feel it should be noted it's not the recommendation that ACIP published or the CDC or (as far as I can tell) any states proceeded with.
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