Pandemic rules and the law: Shad Saleem Faruqi

‘Those in positions of authority must also remain cognisant of the rule of law dimension. Power is not inherent. It must be derived from the law and its exercise must remain within the four corners of the enabling legislation.

‘From the rule-of-law point of view, an executive order, policy, directive, instruction or scheme does not amount to ‘law’ (and thereby require obedience) simply because of expediency, workability or reasonableness. It must be anchored in and derived from legislation or subsidiary legislation.‘

Read here (The Star, March 26, 2020)

The psychological impact of quarantine and how to reduce it: Rapid review of the evidence

‘The December, 2019 coronavirus disease outbreak has seen many countries ask people who have potentially come into contact with the infection to isolate themselves at home or in a dedicated quarantine facility. Decisions on how to apply quarantine should be based on the best available evidence. We did a Review of the psychological impact of quarantine using three electronic databases. Of 3166 papers found, 24 are included in this Review. Most reviewed studies reported negative psychological effects including post-traumatic stress symptoms, confusion, and anger. Stressors included longer quarantine duration, infection fears, frustration, boredom, inadequate supplies, inadequate information, financial loss, and stigma. Some researchers have suggested long-lasting effects. In situations where quarantine is deemed necessary, officials should quarantine individuals for no longer than required, provide clear rationale for quarantine and information about protocols, and ensure sufficient supplies are provided. Appeals to altruism by reminding the public about the benefits of quarantine to wider society can be favourable.’

Read here (The Lancet, Feb 26, 2020)

Caregiving and the soul of medicine: Discussion among Eric J Topol, Abraham Verghese and Arthur M Kleinman

Kleinman: ‘It's surprising that I learned this from my personal experience; I should have known it from my professional experience—but care does not end with the death of the person you're caring for. You're caring for memories after that. A clinician also cares for memories, remembering how to think about the care and how to perhaps use a particular case to improve care in the future. The family member, of course, is rebuilding a story about one's life and one's family. Central to that is the memory of the care you gave and what you've gone through. The attention to those memories, their ordering, the time we spend developing them becomes a very important part of our lives after the practical acts of care no longer need be given because the person has passed. Those are the kinds of things I was concerned with.

‘I came to realize two things: First, that care was disappearing from clinical medicine, that clinicians have become so tied up with technologies, and so tied up with delivering the technologies effectively, that they are forgetting about the role that care plays. And second, there's some question as to whether in the future, even in families, we'll have care, given the limited time that family members have today, the fact that both husbands and wives work—this was women's work in the past—and men in our time, no matter how "woke" and liberated they claim to be, are not picking up the task of care.’

Eric J. Topol, MD, is one of the top 10 most cited researchers in medicine and frequently writes about technology in healthcare, including in his latest book, Deep Medicine: How Artificial Intelligence Can Make Healthcare Human Again.

Abraham Verghese, MD, is a critically acclaimed best-selling author and a physician with an international reputation for his focus on healing in an era when technology often overwhelms the human side of medicine.

Arthur M. Kleinman, MD, MA, is a founder of the field of medical anthropology. He has written over 40 books, including The Illness Narratives: Suffering, Healing, and the Human Condition. His latest book is The Soul of Care: The Moral Education of a Husband and a Doctor.

https://www.medscape.com/viewarticle/920514#vp_3

View video and read transcript here (Medscape, Nov 19, 2019)

Google health-data scandal spooks researchers. Something to think about as we use big data to help in healthcare

Last year, before the Covid-19 outbreak, ‘Google and one of the largest health-care networks in the United States are embroiled in a data-privacy controversy that researchers fear could jeopardise public trust in data-sharing practices and, potentially, academic studies.

’At issue is a project dubbed Nightingale that gives Google access to the health-care information, including names and other identifiable data, of tens of millions of people without their knowledge. The people were treated at facilities run by the health network Ascension, which is based in St Louis, Missouri.’

Read here (Nature, November 19, 2019)

Economic growth is an unnecessary evil, Jacinda Ardern is right to deprioritise it

‘New guidance on policy suggests all new spending must advance one of five government priorities: improving mental health, reducing child poverty, addressing the inequalities faced by indigenous Maori and Pacific islands people, thriving in a digital age, and transitioning to a low-emission, sustainable economy.

‘Take a look at the biggest problems faced world-wide and you would be hard pushed to find examples that are more grave than the ones set out in Ardern’s provisional proposals. Rising inequality, a mental health crisis and climate change are all significant threats, but as long as other major economies prioritise economic growth over wellbeing New Zealand may become a lone wolf trapped in an increasingly hungry bear pit.’

Read here (The London Economic, May 31, 2019)

The new astrology: By fetishising mathematical models, economists turned economics into a highly paid pseudoscience

‘Nonetheless, surveys indicate that economists see their discipline as ‘the most scientific of the social sciences’. What is the basis of this collective faith, shared by universities, presidents and billionaires? Shouldn’t successful and powerful people be the first to spot the exaggerated worth of a discipline, and the least likely to pay for it?

‘In the hypothetical worlds of rational markets, where much of economic theory is set, perhaps. But real-world history tells a different story, of mathematical models masquerading as science and a public eager to buy them, mistaking elegant equations for empirical accuracy.’

[Note: This is an old article published April 4, 2016. We should read this in the context of the epidemiological modelling being used now to forecast Covid-19.]

Read here (Aeon, April 4, 2016)

The Thucydides Trap: Are the US and China headed for war? (written in 2015)

‘But if anyone’s forecasts are worth heeding, it’s those of Lee Kuan Yew, the world’s premier China watcher and a mentor to Chinese leaders since Deng Xiaoping. Before his death in March, the founder of Singapore put the odds of China continuing to grow at several times U.S. rates for the next decade and beyond as “four chances in five.” On whether China’s leaders are serious about displacing the United States as the top power in Asia in the foreseeable future, Lee answered directly: “Of course. Why not … how could they not aspire to be number one in Asia and in time the world?” And about accepting its place in an international order designed and led by America, he said absolutely not: “China wants to be China and accepted as such—not as an honorary member of the West.’

Read here (The Atlantic, Sept 24, 2015)

Case for wearing face masks (1): People who wore masks during the SARS outbreak had a 70% lower risk of being diagnosed compared with those who never wore masks

‘We also used this investigation to quantify the impact of behaviours (i.e. mask wearing, handwashing) that were promoted to reduce the risk for SARS. Wearing masks outside the home in a reference period corresponding to the 2 weeks before symptom onset for cases was significantly protective against clinical SARS.

‘Supporting the validity of this finding, there was a dose-response effect: by multivariable analysis, persons who always wore masks had a 70% lower risk of being diagnosed with clinical SARS compared with those who never wore masks, and persons with intermittent mask use had a 60% lower risk.’

Read here (NIH, 2004)