Posted on by rjonakait

So Many Unanswered Questions (II)

My last post discussed some unintended consequences from policy decisions made during the Covid pandemic. One issue was the misinformation and disinformation that occurred during the period and raised the question of who should be the arbiter of “truth” and how it should be determined for such public health-related policies. One continuing issue of dangerous misinformation has arisen during the tenure of Robert F. Kennedy, Jr., as head of the Department of Health and Human Services. It surrounds the controversial issue of vaccinations.

The controversy appears to have begun in 1998 when Andrew Wakefield and colleagues famously published in The Lancet, one of the world’s leading medical journals, case studies that purported to show a link between the measles, mumps, and rubella vaccine and autism. Many, many other studies in response, however, found no connection between autism and the MMR vaccine. Further investigation showed that Wakefield had conflicts of interest and that he had altered patient medical histories and fabricated data. In 2004, Wakefield co-authors partially retracted the 1998 conclusions, and in 2010, The Lancet unconditionally retracted the original paper. Also in 2010, Wakefield was stripped of his license to practice medicine in the United Kingdom because of his serious professional misconduct. Study after study since then has shown that the MMR vaccine does not cause autism.

This story is recounted by Kira Ganga Kieffer in Unvaccinated Under God: Religion and Vaccine Hesitancy in Modern America (2026). She also presents the depressing news that more than a decade after Wakefield’s paper was withdrawn and dozens of studies showing it was wrong, one in three Americans believe the MMR vaccine causes autism. Kieffer makes clear that this scenario is not limited to that one vaccine. After the Covid vaccine was developed, stories circulated that it was unsafe. As information poured in, however, it became clear that not only was the Covid vaccine efficacious, it was safe with only very rare, and almost always minor deleterious side effects. Even so, Kieffer reports that few people who had believed the vaccine was dangerous changed their minds even in the face of the mounting data that their belief was wrong.

Kieffer identifies a part of human nature that tends to reject information that is unsatisfying. We want to know the cause of an infirmity. I have a cold or the flu. Who gave it to me? My child has autism. What is the cause? It gives some parents satisfaction to tell them that it was the MMR vaccine. Information tends to be rejected that says that the cause is unknown, but it was not that vaccine. Similarly, what caused my recent illness? Oh, I had the Covid vaccine just before I got sick. The vaccine must have caused it.

While we should be grappling with the rejection of good information for misinformation and disinformation, the problem is only getting worse. We now have a government that regularly promotes misinformation and disinformation not just on healthcare issues but on many topics. Steven Macedo and Frances Lee, who are critical of many Covid policies in their book, In Covid’s Wake: How Our Politics Failed Us (2024) also maintain it is hard to credit what Trump and Republicans say when they are election deniers, climate change skeptics, and deny structural racism.

Macedo and Lee also discuss the difficult weighing of the health benefits of the Covid policies against their negative collateral consequences. Kieffer raises another difficult balancing act for vaccines generally.

In the 1960s and the 1970s every state mandated the immunizations recommended by the Centers for Disease Control for school attendance but also allowed non-medical exemptions for religious or personal reasons. According to Kieffer, few exemptions were sought until the 2010s when some ultra-orthodox Jewish communities and some evangelical Christians, groups already prone to government opposition, adopted vaccine hesitancy as a moral or religious commitment. Vaccine mandate exemptions have since increased. They get support from some government officials such as Rand Paul, who has denounced such mandates as violations of parental rights. Kieffer states that an animating issue for Covid vaccine hesitancy was not so much the safety of the vaccine but the question of personal liberty.

The vaccine resisters, however, have still benefited from vaccines. When enough other people get vaccinated, herd immunity develops and both the vaccinated and unvaccinated benefit. If there are enough resisters, however, herd immunity breaks down. Resisters may say it is my choice not to take the vaccine. I risk the consequences. You can get vaccinated, and you will be protected. There are flaws in this logic, however. Vaccines often are not given to infants in the first year of life. Normally, they are protected by herd immunity, but they will not have that protection if many do not get vaccinated. Furthermore, while the vaccines are efficacious, the efficacy is never 100%. Even a small number of the vaccinated can get the disease.

The decision not to be vaccinated is not just a personal choice; it affects society as a whole. A difficult question then becomes when do claims of “religious freedom,” “personal liberty,” and “parental rights” outweigh societal safety?

Posted on by rjonakait

So Many Questions Unanswered

The Senate hearings a few weeks ago that were supposedly about the origins of the Covid virus were a disappointment. We need a better understanding of the pandemic and our responses to it, but what we got was an attempt to blame and shame rather than a serious proceeding to obtain and share information. We need to understand what happened and what can be improved for the next pandemic, which will inevitably come. We did not get that.

A starting point should be that Covid was deadly for many. Steven Macedo and Frances Lee wrote an informative book about the subject, In Covid’s Wake: How Our Politics Failed Us (2024). It horrifically reports that an estimated 1.7 million people in the United States died because of the pandemic. Most of the deaths were directly from Covid, but some excess deaths during the pandemic were from causes not directly related to the virus but from other conditions like heart disease, diabetes, and homicide. Macedo and Lee stress time and again that our policies produced collateral consequences that were not always understood at the time. For example, the lockdowns led to fewer health visits and increased stress. These subsequently led to increased deaths.

We, of course, want to lessen deaths, but how should we address other less visible harms that may develop over a longer period? For example, every state closed their schools in March 2020 causing, according to Macedo and Lee, the most significant educational disruption in history. These schools remained closed long after it was clear that they were not important drivers of community infection.

Examples like this raise questions about how to set, and perhaps even more important, reset policies, particularly when there is fast developing but incomplete information, some of which will turn out to have been inconsistent. Authorities who have implemented rules and guidelines will find it hard to change what has been previously ordained. The authority will feel–at least subconsciously–that any change will seem like an admission that what was set before was a mistake, even if it was the best choice utilizing the currently available information. It is hard to change course especially when that course is public and has affected others. Under these circumstances, human nature resists new information that contradicts what has already been decided. For example, at the beginning of the pandemic, it was assumed that Covid affected all ages at the same rate. Portions of Italy were among the first places to be hard hit by Covid, and reports from there indicated that those under forty were at low risk, while the aged were at high risk. That information took too long a time to influence the United States. Schools remained closed longer than they needed to. Although a shibboleth states that states trying out different ideas serve as a laboratory of democracy—one state tries something and other states learn from it. Some states relied on strict non-pharmaceutical interventions—social distancing, masking, lockdowns. These made some sense in light of the fact that early reports indicated that China contained the spread of Covid with them. It was soon clear (to some), however, that states that implemented these tactics did not have better mortality outcomes, while states with high vaccination rates did. This knowledge did not seem to affect state or local policies. New York did not try to learn from Florida, and Florida did not try to learn from Michigan.

In Covid’s Wake avers that the most difficult question was balancing harm from Covid itself versus the harms stemming from Covid policies. How, for example, do we weigh decreased deaths against decreased childhood learning? Can we justify decreased hospitalizations if it means hardship imposed on the economically disadvantaged–on those who disproportionately lost their jobs, saw their children fall behind in school, and suffered more from Covid disease and death because they comprised the bulk of our “essential workers”? Macedo and Lee contend that it was an error of Covid policy to give too much power to public health officials whose narrow concerns and expertise focus only on morbidity and not on the collateral consequences of public health interventions. Is that something we should learn?

The authors maintain that legislatures should have played a bigger part in setting Covid policies. Looking at the problem theoretically, this might be right. Elected representatives are supposed to be the prime policymakers weighing the costs and benefits of public policies. In practice, however, how nimbly can legislatures perform during a pandemic when information is fast-developing, and policies need constant reevaluation and possible revision? Legislatures are too cumbersome to assimilate new data and quickly alter the course that has been set.

Legislatures also do not seem to be ideal bodies to deal with rampant misinformation and disinformation. Macedo and Lee posit that elite groups–like medical and scientific professional–have a tendency for groupthink that reinforces their own biases. They argue that we should be hesitant of giving these professionals the power to police the “truth.” Their conclusion, however, does not tell us how to determine what is misinformation and disinformation, who should make the determination, or how to deal with misinformation and disinformation once it is identified. History shows that we cannot just pretend it will not have an effect.

Posted on by rjonakait

First Sentences

“Charles Mitchell strode up the steps of 55 Wall Street, determined to project his usual sense of confidence and certitude.” Andrew Ross Sorkin, 1929: Inside the Greatest Crash in Wall Street History—And How it Shattered a Nation.

“‘We hold these truth to be sacred. . .’ Sacred? No. That doesn’t sound right.” Walter Isaacson, The Greatest Sentence Ever Written.

“Few Americans understand just how great the Great Lakes really are.” John U. Bacon, The Gales of November: The Untold Story of the Edmund Fitzgerald.

“The fear that gripped the world in March 2020 is not something we will soon forget.” Steven Macedo & Frances Lee, In Covid’s Wake: How Our Politics Failed Us.

“A black man in a white hat stood sleeping against a brick wall.” Michael Rips, The Golden Flea: A Story of Obsession and Collecting.

“In the Roaring Twenties, the famous philanderers William Randolph Hearst and Babe Ruth might have thought it, but only Henry Ford said it out loud: Housewives of America should be patient with outbreaks of marital infidelity.” Gary M. Pomeranz, The Devil’s Tickets: A Night of Bridge, a Fatal Hand, and a New American Age.

“On the night the ships appeared, some fishermen were out on the ocean, working by torchlight.” Hampton Sides, The Wide Wide Sea: Imperial Ambition, First Contact and the Fateful Final Voyage of Captain James Cook.

“The first time it happened I was in a stall in a public bathroom just off Wall Street in Manhattan.” Naomi Klein, Doppelganger: A Trip into the Mirror World.

“‘Have you ever thought what you are going to do when you get out of High School?’ asked an editorial in Rahway High’s Scarlet and Black.” Jennifer Burns, Milton Friedman: The Last Conservative.

“There was a buzz of excitement when I arrived at my Harvard office at 78 Mt. Auburn Street on a June morning in 1972.” Doris Kearns Goodwin, An Unfinished Love Story: A Personal History of the 1960s.

“Fred Rogers had given some very specific instructions to David Newell, who handled public relations for the PBS children’s show Mister Rogers’ Neighborhood.” Maxwell King, The Good Neighbor: The Life and Work of Fred Rogers.

“I like to probe the darkness at the edges of our nation’s history.” Nathaniel Philbrick, Travels with George: In Search of Washington and His Legacy.

“The glass doesn’t just break, it explodes into hundreds, thousands of pieces.” Andrew McCarthy, Walking with Sam: A Father, a Son, and Five Hundred Miles Across Spain.

“One of the great myths of our criminal system is that minor arrests and convictions are not especially terrible for the people who experience them.” Alexandra Natapoff, Punishment without Crime: How our Massive Misdemeanor System Traps the Innocent and Makes America More Unequal.

“The Indian Nation turnpike is a four-lane highway cutting north to south through the bottom right corner of Oklahoma.” Rebecca Nagle, By the Fire We Carry: The Generations-Long Fight for Justice on Native Land.

Posted on by rjonakait

Some Books I Do Remember

I look over the books I read in 2025. Many I can’t seem to recall at all. Others I vaguely remember. But a few have stuck with me.

Orbital by Samantha Harvey. Twenty-four hours orbiting the earth. I did not like this slim, Booker prize winner as much as some friends did, but the poetic meditations made it worthwhile.

When Women Ran Fifth Avenue: Glamour and Power at the Dawn of American Fashion by Julie Satow. I was not familiar with this history of remarkable women who transformed department stores in mid-twentieth century New York City.

The Fish Can Sing by Halldór Laxness. Any writing by Iceland’s Nobel Prize Winner is worth reading.

V13: Chronicle of a Trial (Translated from the French by John Lambert) by Emmanuel Carrère. A great book about the trial of terrorists who slaughtered many in Paris on Friday November 13, 2015.

32 Yolks: From My Mother’s Table to Working the Line by Eric Ripert. This memoir from the renowned chef is surprisingly good but also disappointing. It ends too soon. I wanted to learn more about his later life, but if he has written about that, I have not found it.

The Personal Librarian by Marie Benedict and Victoria Christopher Murray. This fictional biography of Bella de Costa Greene is not great literature, but Greene’s story—born Black, lived as a white, became J.P. Morgan’s librarian—is a great one.

Working: Researching, Interviewing, Writing by Robert A. Caro. Learning how a great craftsman crafts is always fascinating.

Strangers in the Land: Exclusion, Belonging, and the Epic Story of the Chinese in America by Michael Luo. An important but often overlooked part of our history.

Imperial Twilight: The Opium War and the End of China’s Last Golden Age, by Stephen R. Platt. Picked by my history book group, I expected an academic slog, but Platt made this into a page turner.

My Friends, by Fredrik Backman. This, as is anything written by Backman, is worth reading.

The Princess Bride: S. Morgenstern’s Classic Tale of True Love and High Adventure by William Goldman. A delight for all ages.

The Maid by Nita Prose. A mystery story with a different, often amusing, main character.

Sonny Boy by Al Pacino. I resist most memoirs and especially those of show biz celebrities, but I saw several comments about how good this book is. I pulled it off a library shelf and loved it.

The Complete Persepolis by Marjane Satrapi. I had seen the great movie Persepolis when it came out but only now read the graphic novels that inspired the film. They are also great.

The Mission: The CIA in the 21st Century by Tim Weiner. I don’t remember many details even though I read the book recently, but Weiner gives us an important and depressing look at the country.

The Gales of November: The Untold Story of the Edmund Fitzgerald by John U. Bacon. Taught me a lot about the commercial importance of the Great Lakes and the dangers of their waters as well as about the Edmund Fitzgerald. The book is another surprising page turner.

The Good Neighbor: The Life and Work of Fred Rogers by Maxwell King. Learned many fascinating facts and insights about an important but now often overlooked person.

In Covid’s Wake: How Our Politics Failed Us by Steven Macedo & Frances Lee. A significant, critical examination of our responses to Covid. I am still coming to grips with this book and hope to write about it soon.