I Reject Your Medical Reality and I Substitute Death

I am, no surprise, a big fan of reality. I think I have a reasonable approximation of what reality is, mostly understood through the lens of the sciences. I learned early in my edumacation the key word is approximation. Always approaching a complete picture of life, the universe, and everything asymptotically. Zeno’s paradox is the best representation of to how I acquire understanding.

Not everyone is a fan of reality. I remember being amused back in the day by Adam Savage’s tag line of,”I reject your reality and substitute my own.” As a sci-fi guy who read a lot of alternative (complementary? integrative?) history, I thought it funny. But to a rather worrisome degree, it defines many people, except for the obvious (to me) fact that there are no other realities that can be slotted in at will.

I have often thought it should be reality-based medicine. In part, because the SCAM proponents use science, albeit, with a more Dr. Science kind of ineptness, to justify their practices, and in part it offers an easy opposite. What is the opposite of science-based medicine? The antonyms of science do not roll trippingly off the tongue, although I do kind of like witlessness-based medicine as an alternative to alternative medicine. But the opposite of reality? Fantasy-based, delusion-based, or fiction-based medicine sum the not-so-distinguished competition up so much better.

Denying reality has consequences. Few, rock climbers excepted, deny, say, the existence of gravity. Planes and bridges are not built using alternative ideas as to what constitutes gravity. The earth sucks, as an example, is not a workable construct for keeping a plane aloft.

Medicine seems particularly prone to people denying reality and substituting their own. It often doesn’t work out well. I saw many examples in my long and storied career. The first case was as a medical student doing my ER rotation. Guy came in weak with a low blood pressure and a very low hemoglobin (a measurement of how much red blood cells are in the circulation). A slow bleed, from a gastrointestinal cancer, was on the list of reasons, but taking off his shirt to listen to his lungs revealed a huge, mushroom-shaped melanoma that was oozing blood. He denied its existence. He was not the only patient I saw over the years who presented with huge, necrotic tumors whose presence were denied by the patient. Some were the size of dinner plates and the patient would say, nope, hadn’t noticed.

I have mentioned in the past the case that got me involved in SCAMs. I was called for a consult for a leg infection. Rather than an infection, it was a young female with a dead, rotting leg from a progressive sarcoma being very unsuccessfully treated by a naturopath. The tumor eroded that night into an artery and she died. ND. Not a Doctor.

I also saw many a patient who denied their AIDS diagnosis, refused care, progressed and died.

Note a pattern: reject medical reality and die.

There were no end of deaths from COVID in those who denied COVID, its prevention, appropriate treatment or the benefits of the vaccine. Reality substitution seemed to have a particular predilection for conservative talk show hosts

no less than five conservative radio talk show hosts who urged their audiences to avoid vaccines for COVID-19 have died from the virus.

Far be it for me to suggest any schadenfreude. Those COVID deaths from reality substitution were mostly anecdotes, not a careful evaluation of the epidemiology of the consequences of ignoring reality.

The epidemiology of COVID changed as the virus washed back and forth over the US. It started in the blue NW and took its time to reach the red South. The disease evolved and along with it our understanding of its spread, its treatment and prevention. So early on it was difficult to make hard-and-fast rules about who gets COVID and why, given all the flux and variation.

This was noted in early studies as COVID wandered from blue to red states.

From March 2020 to early June 2020, Republican-led states had lower COVID-19 incidence rates than Democratic-led states. On June 3, 2020, the association reversed, and Republican-led states had a higher incidence (risk ratio=1.10, 95% posterior interval=1.01, 1.18). This trend persisted through early December 2020. For death rates, Republican-led states had lower rates early in the pandemic but higher rates from July 4, 2020 (risk ratio=1.18, 95% posterior interval=1.02, 1.31) through mid-December 2020.

And while the death rates/100,000 were higher in states with Republican Governors, the comparisons were not at a steady state for the disease in the country.

Substituting reality by ignoring masking and social distancing before the vaccine was variable and direct comparisons of red or blue were problematic. The trend towards more reality substitution in red areas and subsequent suboptimal consequences appeared real and was plausible from basic infection control practice. Reality substitution is a bad idea in the hospital for infection control, there would be no reason to suspect the same principals would not apply in the real world.

So, when did we reach steady state with COVID? Got me. Sometime after the vaccine was released and after the entire country had seen the first wave would be one reasonable, or arbitrary, point. And that brings us to the most recent reality denial paper, Excess Death Rates for Republican and Democratic Registered Voters in Florida and Ohio During the COVID-19 Pandemic

Between January 1, 2018, and December 31, 2021, there were 538 159 individuals in Ohio and Florida who died at age 25 years or older in the study sample. The median age at death was 78 years (IQR, 71-89 years). Overall, the excess death rate for Republican voters was 2.8 percentage points, or 15%, higher than the excess death rate for Democratic voters (95% prediction interval [PI], 1.6-3.7 percentage points). After May 1, 2021, when vaccines were available to all adults, the excess death rate gap between Republican and Democratic voters widened from -0.9 percentage point (95% PI, -2.5 to 0.3 percentage points) to 7.7 percentage points (95% PI, 6.0-9.3 percentage points) in the adjusted analysis; the excess death rate among Republican voters was 43% higher than the excess death rate among Democratic voters. The gap in excess death rates between Republican and Democratic voters was larger in counties with lower vaccination rates and was primarily noted in voters residing in Ohio.

How widely applicable the results are is uncertain, but it is in agreement with the general trend that denying reality and substituting your own can be fatal, at least in medicine. It still worked well as a concept in MythBusters.

But consider the close election of 2024.

Arizona had 6400 COVID deaths as of November 2020 on their way to 30,000 as of this month.
Biden won by 10,000 votes in 2020.

Georgia had 8500 deaths on the way to 35,000.
Biden won by 12,000 votes.

Wisconsin had 3000 deaths on the way to 16000.
Biden won by 20,000.

Republicans had a 43% higher death rate since the vaccine was introduced and a 15% higher death rate before the vaccine.

Ballpark calculations, and there are all sorts of ways to crunch the numbers depending on the breakdown of party affiliation, age, etc., suggests that reality denial may have helped prevent the re-election of Donald Trump. Odd to think about, but the Red Cult of Death’s reality substitution may have helped swing the election to Biden, what with the electoral college and all. Trump still would have lost the popular vote.

And for 2024 there will be more red dead than blue dead. Supporting policies that kill your constituents may be counterproductive to electoral victory. If a similarly close race happens in 2024, it may not be the dead who vote that make a difference, but the COVID dead who can no longer vote. Red Dead and no Redemption My son played that game during COVID; I particularly liked that the main character caught TB and died of it. Didn’t wear a mask or socially distance when it may have helped.

Someone with a more sophisticated understanding of the numbers should do the calculations across the US as of November 2022 and see how reality denial affected the election and might alter future elections.

In the meantime, I will continue to voice my support for reality in all its approximations, regardless of the electoral consequences.

  • Mark Crislip, MD has been a practicing Infectious Disease specialist in Portland, Oregon, from 1990 to 2023. He has been voted a US News and World Report best US doctor, best ID doctor in Portland Magazine multiple times, has multiple teaching awards and, most importantly,  the ‘Attending Most Likely To Tell It Like It Is’ by the medical residents at his hospital.

    His multi-media empire can be found at edgydoc.com.

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