The author Douglas Adams once likened grand pontifications about human existence to a sentient puddle believing it has purpose. The collection of water looks at its surroundings and reasons it must be special since it fits perfectly in its very own hole. That can’t be by chance, can it? In fact, it might create an entire belief system about how it’s a divinely inspired puddle, which was created as the only one at the center of the universe. And if it’s meant to be there, then the puddle develops an inflated sense of confidence that it will always be there. But as the sun starts rising in the sky, and the puddle gets smaller and smaller, difficult decisions have to be made: Does the puddle continue to grasp for fantasies and fairy tales as the water evaporates away? Does it concoct desperate ideas of how it will be saved, and wild conspiracies for what’s behind its dire situation? Or does it face hard truths?
The current crisis the world faces is but one where ignorance has doomed it to death and suffering that’s avoidable. People accept situations the way they want to believe, or in ways they can understand, instead of the truth as it actually exists. One of the ways that’s done is by buying into comfortable fictions. To that end, there are certain cultural cliches we accept in the shorthand of storytelling but are not even remotely true: Horses galloping don’t sound like clanging coconuts. There aren’t nearly as many criminals and serial killers as Law & Order or C.S.I. would seem to indicate, and doctors don’t shock a flatline (asystole) in dying patients, sending their bodies jumping six inches into the air before getting them breathing again. People believe they need to drink eight glasses of water a day, or that humans only use 10% of our brains, or going out with a wet head will make people sick because they read or saw it somewhere, even though none of it is true. This tendency to filter reality through fantasy and myth is especially true in medicine when it doesn’t fit the misconceptions—and that’s when the conspiracy theories start. Even before the novel coronavirus affected all of our lives, getting people to vaccinate their children had become an ordeal where segments of the public had to be begged and pleaded with as centuries of science competed against the nonsense of what some idiot posted on Facebook.
It might be interesting to look at some of the more common myths, the reality, and why there can be a disconnect between the public and the truth. Is there something cultural where a complex topic leads to people finding it easier to filter everything through the fiction we use to explain sickness and death? Does the cultural cynicism about government and institutions play into difficulties in getting people to understand, whether it be issues about a pandemic or considering the best way to deal with health insurance policy? Whenever science and superstition have conflicted over the years, medicine has been repeatedly caught up in that battle.
About seven centuries ago, the Black Death killed tens of millions and is estimated to have wiped out as much as 60% of Europe’s population. In a time of sickness and death, fear has a way of driving desperate people to believe in ridiculous things. One of the prevailing theories at the time posited that plague, as well as other diseases such as cholera and chlamydia, were caused by miasma—noxious odors in “bad” air contaminated by decaying organic matter—causing an imbalance in a person’s bodily fluids. In order to combat such things, people from the Middle Ages to the 19th century attempted such plague cures as setting bonfires on the streets to burn away the impurities blowing in the wind, aromatherapies where plague doctors doused themselves in smells and dressed up like birds, all the way to sitting in sewers in the hope that the foulness of the stench would protect them. And when all of that failed, some decided it was time to kill all the Jews as scapegoats and seize their property.
While we can read about this history and shake our heads, we have not come so far as to be immune from that kind of hysteria. In fact, one doesn’t need to look far to see it right here with us in the 21st century.
We are a species that has achieved great wonders, with many having laid down their lives for the betterment of others. Yet we are also a people who have stooped low, up to and including stupidly ritually sacrificing our own children to things that never were in the vain desperation to cheat death for just one more day. Instead of killing people to gain the favor of the gods, the sacrifices of today are done in the name of personal vanity and feigned enlightenment. Instead of just trying to quell the mystical unseen forces of mythical beings that played into the medical myths of yesteryear, stupid people create and buy into unconfirmed speculations about the nefarious unseen forces of secret government plots and massive conspiracies. This can be seen all too often in the current crisis.
Here’s a selection of the myths of the present that have gained a hold on social media and will undoubtedly lead to the shaking of people’s heads in the centuries to come:
These are explanations that are meant to fill in the gaps in any way possible, through bias, suspicion, and paranoia. Instead of admitting “we don’t know,” a more exciting fantasy becomes a conversation starter and Twitter fodder. And the framing of how we talk about these things matters. When someone calls COVID-19 a “Chinese virus,” just remember that HIV/AIDS was once called a “gay virus/disease” and referred to as such (i.e., GRID, or Gay-Related Immunodeficiency), and think about how that colored the response—or lack thereof.
An interview with epidemiologist Don Francis done by Frontline confirmed the essence of the scene above. Keep in mind the event occurred during a time when President Ronald Reagan did not utter the word “AIDS” until over 5,000 Americans were dead, and most of the media ignored the story and treated HIV/AIDS as a “gay disease” until the death of actor Rock Hudson.
On three separate occasions, Reagan press secretary Larry Speakes and the Washington press corps joked and laughed about HIV infections.
Don Francis: In January of '83, we had the meeting with the blood banks that we thought, frankly, was going to be a straightforward meeting. We presented data. We showed them ways they could avoid this. They could use laboratory tests; they could use histories of volunteers like they always had used, laboratory tests fitting into their system. And they obstructed it from the get-go. It was as frustrating a [meeting] as I've ever been in. And yes, I pounded the table and yelled at them, asking them how many people they wanted to kill. If it's five now, instead of having another meeting of this kind, I just said: "Just tell us the number. You want 10 dead? You want 20 dead? You want 100 dead? Then we'll make these [recommendations]. We can make the recommendations today, and then you can just count the cases." That didn't go down very well.
The gulf between how people think medicine works and medical reality can be wide at the best of times. Below are several more widely believed medical myths, and how well they either do or don’t fit with the truth.
- MYTH: CPR is almost always effective. The public's perception of how cardiopulmonary resuscitation (CPR) is performed and its effectiveness are a bit skewed. A study published in the New England Journal of Medicine in 1996 found that 75% of fictional patients in movies, TV, etc., enjoyed immediate recovery from CPR, while the actual rate of meaningful survival is typically well below 30%. CPR alone has only a 2% chance of reviving someone with no pulse. This is true because CPR is NOT a lifesaving procedure that will just bring someone out of unconsciousness or a death spiral. It's a life-prolonging measure that buys time until a doctor can treat the underlying problem.
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MYTH: Bacteria and viruses mutate into the most efficient form for killing humans. The evolution of viruses and bacteria operates under the same principles as it does for humans, which is usually much different from the way Hollywood portrays it. In a time when a significant portion of the population has trouble accepting a cornerstone of modern biological science, the perception of evolution is a bit skewed in pop culture. Some have the mistaken impression that evolution is somewhat synonymous with progress, and things get more complex and better as they evolve. It's a common trope in science fiction, where future humans get superpowers like the X-Men, or become god-like energy beings. But species evolve into whatever they evolve into because whatever that ends up being is the most fit to survive in its environment. There are no guarantees of increased functions or cool new abilities. And in most movies and TV shows, viruses and bacteria evolve into whatever form is necessary to kill humans in the worst possible way ... just because. For example, during the Ebola virus scare of 2014, there were multiple stories written about the "possibility" of Ebola becoming airborne. The Ebola virus latches onto receptors outside endothelial cells lining the circulatory system. To become airborne, it would have to mutate into a virus that can attach to the alveolar cells of the lungs. That would be the equivalent of humans mutating and growing a set of wings ... just because.
Reporter Carl Zimmer has a piece in The New York Times detailing new research indicating the strain of coronavirus affecting New York may have been brought in from Europe instead of Asia, a conclusion come to when analyzing the genome of virus samples from both New York and Washington state.
The coronavirus genomes are also revealing hints of early cross-country travel.
Dr. van Bakel and his colleagues found one New York virus that was identical to one of the Washington viruses found by Dr. Bedford and his colleagues. In a separate study, researchers at Yale found another Washington-related virus. Combined, the two studies hint that the coronavirus has been moving from coast to coast for several weeks.
Sidney Bell, a computational biologist working with the Nextstrain team, cautions people not to read too much into these new mutations themselves. “Just because something is different doesn’t mean it matters,” Dr. Bell said.
Mutations do not automatically turn viruses into new, fearsome strains. They often don’t bring about any change at all. “To me, mutations are inevitable and kind of boring,” Dr. Bell said. “But in the movies, you get the X-Men.”
Peter Thielen, a molecular biologist at the Johns Hopkins Applied Physics Laboratory, likes to think of the spread of viruses like a dandelion seed landing on an empty field. The flower grows up and produces seeds of its own. Those seeds spread and sprout. New mutations arise over the generations as the dandelions fill the field. “But they’re all still dandelions,” Mr. Thielen said.
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MYTH: If someone coughs, they're going to die. This is sort of a Goldilocks example of artistic sickness in TV and movies. TV Tropes calls it the “incurable cough of death.” Sneezing doesn't seem serious enough, you can't really visualize a fever, seizures are too severe, and vomiting is too gross. So most media depictions of illness are signified with a cough, which eventually turns into a cough with blood, and it’s the first sign of terminal disease. Of course, not every cough is a harbinger of death. But there is a tinge of truth in television with this, since tuberculosis, also known by its old time-y name of “consumption,” is currently second only to HIV/AIDS as the greatest killer worldwide due to a single infectious agent. Tuberculosis still kills about 2 million people per year, and has been killing humans in large numbers since antiquity. The classic symptom of tuberculosis is a chronic cough that leads to a slow and agonizing death, if untreated.
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MYTH: Everyone is susceptible to everything, and the mortality rate is 100%. In most TV shows and movies, whatever pandemic is affecting the population infects everyone it comes across, and that infection is an automatic death sentence. Everyone bitten by a zombie becomes a zombie. If a researcher's "space suit" gets ripped, that's all the evil infection needs to get inside. If one of the infected people coughs in someone else's face, too bad, so sad. And from there the pandemic spreads in a geometric progression. The good news is that it's highly unlikely the human race will ever be totally wiped out by a virus, even a super virus. For example, there are mutations present in some segments of the population that give individuals resistance and possible immunity to the HIV virus. The mutation has been the source of research into a possible treatment and control of HIV. And the underlying science is true for most of the viruses that have been fodder for the imagination, since it's theorized some portion of the population will be resistant or naturally immune. Also, while there are viruses and bacterial infections that have case fatality rates near 100%, it's usually for untreated infections. On the other hand, as we have seen recently, it doesn’t take a huge morbidity and mortality rate to greatly affect a functioning society. The Spanish flu of 1918 was one of the biggest killers in human history and was responsible for the deaths of "only" about 3-5% of the world's population at its height. It infected around 500 million people and killed as many as 100 million. That's more people than the total dead of both world wars combined.
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MYTH: The government and public health response is mired in fear and politics. In most films and TV shows, government and medical professionals are horribly inept in responding to the danger, often leaving the main character as the "only sane person" in a sea of stupidity. But that's usually a function of what's necessary for the premise in the first place. A story can't have a pandemic spread far and wide without either the pathogen being unlike anything here in the real world or people doing the dumbest possible things and making the worst possible decisions. The truth is somewhere in the middle, and usually is neither as bad as it seems in pop culture or as good as we might hope. Our own history is full of situations in which public policy has been lacking, either by ignoring a problem, not funding the professionals who needed resources to solve it, or wasting time doing things only to look like something was being done. Loudmouths, idiots, and opportunists use the situation to talk about government conspiracies, lie about vaccines, and to spread fear. And this tendency only seems to get worse if the problem occurs around the time of an election.
A 2014 article by Alan Feuer at The New York Times documented the same kind of stupidity during the Ebola outbreak that we’re seeing among the usual suspects—except now it’s the novel coronavirus.
The outbreak began in September, when The Daily Observer, a Liberian newspaper, published an article alleging that the virus was not what it seemed — a medical disaster — but rather a bioweapon designed by the United States military to depopulate the planet. Not long after, accusations appeared online contending that the federal Centers for Disease Control and Prevention had patented the virus and was poised to make a fortune from a new vaccine it had created with the pharmaceutical industry. There were even reports that the New World Order, that classic conspiracy bugbear involving global elites, had engineered Ebola in order to impose quarantines, travel bans and eventually martial law. While most of these theories have so far lingered on the fringes of the Internet, a few stubborn cases have crept into the mainstream. In the last few weeks, conservative figures like Rush Limbaugh and Laura Ingraham have floated the idea that President Obama had sent aid to Africa, risking American lives, because of his guilt over slavery and colonialism. And just days ago, the hip-hop artist Chris Brown took to Twitter, announcing to his 13 million followers: “I don’t know ... but I think this Ebola epidemic is a form of population control.”
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MYTH: A vaccine is produced easily and fast. In most movies, all you need is some blood or tissue from someone immune or resistant to the pathogen and a cure or vaccine can be whipped right up in a matter of days, if not hours. The truth is a bit more formidable. In order to create a vaccine, medical professionals have to first identify the pathogen. That means the virus or bacteria has to be successfully grown in a cell culture and its structures identified through X-ray crystallography. That, in and of itself, takes a bit of time. From there, different vaccine formulas are developed if possible, since there are many pathogens we've identified and mapped for which we still can't synthesize a vaccine. If we can create a vaccine, it still has to be tested, eventually with human trials; final approval by health authorities takes even more time. And that's not the end, since it still has to be manufactured, moved around the globe, and shot into arms or put up noses. And all of this presupposes that people will actually take the vaccine when it becomes available and thus establish herd immunity.
There is nothing wrong with skepticism or critical thought. Where things go off the rails is when people’s cynicism takes hold and decides to create a fantasy as delusional as believing the world has elves and unicorns. Because such a person is certain the universe behaves in a certain way, any information that contradicts this belief must be false, contrived, or concocted, no matter how much evidence to the contrary is produced. If science disagrees with the belief, then science is wrong. When evidence and science disagree with the belief, they are either another part of a conspiracy by “Big (fill in the blank)” or not the "correct" evidence and science, which leads to some absurd pseudoscience arguments. This pattern repeats itself whether one is discussing Barack Obama’s birth certificate, the Sept. 11 attacks, chemtrails, or the people who believe “Big Math” is suppressing their proof of how to square a circle.
But the universe is not governed by individual perceptions and beliefs.
It matters what is true and what isn’t true. The language of how we discuss these things matters too, and there are real costs and repercussions when absurd opinions are given a degree of respect they objectively don’t deserve.