The Fall of Our Institutions: The Blessing of COVID-19

I was in my 4th year of medical school rotating in the Southside of Chicago when I saw a patient who was non-compliant with his treatment plan.

He was a 39-year-old Black patient with congestive heart failure, a condition where the heart fails to pump adequate blood through the circulation.

Although he was advised to wear a “Life Vest” (a portable defibrillator that detects and corrects abnormal heart rhythms), he refused to wear it.

He was not my patient, but was one of several patients that we saw daily for 3 consecutive days.

And each time we saw him, the preceptor insisted, “you should wear your Life Vest. It is going to save your life.” The patient, reluctantly and passively agreed, almost certainly guaranteeing that he will continue to be non-compliant.

On the third day, I decided to stay behind to simply ask the question: “Why are you not wearing the Life Vest?” 

The patient’s answer was a typical answer that I was seeing more and more among my patients, especially during the COVID-19 Pandemic.

“I’m sick of the doctors forcing this on me,” the patient said. “How do I know that they aren’t being paid for pushing this stuff on us?”

Although he was a difficult patient, he demonstrated that although I was a healthcare provider, I could not walk into the room with a white coat and expect trust from a patient. I would need to build and earn that trust. 

I could not help but feel excited. 

The Decline of Public Trust in Institutions

As a free-market advocate, I am constantly questioning existing institutions. 

The problem, of course, is not that institutions should not exist. The problem is the quality of those institutions. And the graveyard of failed institutions is proof that existing institutions should be examined, scrutinized, and if needed, replaced. 

Even free-market advocates (myself included) may have supported the idea that government institutions (especially public health government institutions) may have been a necessary part of promoting public health. Initially, the FDA monitored harmful drugs; the CDC tracked disease trends and the NIH funded research to explore disease trends and effectively guide public policy.

Throughout the decades, all three organizations have slowly transformed into agents of the private sector. The FDA, which started with the stated goal of protecting the public from harmful substances, slowly transformed itself into an arm of the pharmaceutical industry. Similarly, the NIH has become a breeding ground for fraudulent research. 

And while these organizations have had questionable legitimacy for the last few decades, the public lack of trust in these organizations quickly accelerated during the COVID-19 Pandemic.

In the early stages of the pandemic, trust in “medical scientists” hit an all-time high. According to a Pew Poll, those who trusted medical scientists “a great deal” rose from 35% in January 2019 to 43% in April 2020. 

However, by December 2021, we saw a significant decline in trust. Those who trusted medical scientists “a great deal” fell to 29%. 

We also saw a significant decline in trust in the CDC and FDA among healthcare professionals during the Pandemic. 

According to WebMD, 77% out of nearly 2,000 US nurses said that their trust in the CDC had decreased since the start of the Pandemic and 51% said their trust in the FDA had decreased.  

Scandals in the COVID-19 Response

Why the public mistrust? 

While the answer is multifaceted, there are obvious reasons. The intensity of the lockdown policies as well as the forced vaccinations (especially among healthcare workers) certainly played a major role, especially considering that the lockdowns did very little to mitigate the pandemic, and did immeasurable economic damage to those regions that implemented those draconian policies. Thousands of healthcare professionals felt betrayed with the forced vaccine policies and either quit or were fired due to refusing to receive a COVID vaccine. 

But there were, of course, many events throughout the Pandemic that added to the mistrust. One of the first (and perhaps one of the major) scandals in the early months of the pandemic was the debate on the use of Hydroxychloroquine, an anti-malarial and rheumatological drug that has been in widespread use for decades. 

It was initially touted as a potential treatment for COVID-19 by several studies (see studies published by Nature and the American College of Cardiology), especially in the early stages of the disease. 

Hydroxychloroquine was quickly politicized, especially as then President Donald Trump supported its potential benefits in the early stages of the Pandemic.

The controversy of Hydroxychloroquine was worsened when studies in the prominent journal The Lancet published a study demonstrating how Hydroxychloroquine was not only ineffective in treating patients but can actually lead to premature deaths in patients. 

The study was influential. Healthcare organizations throughout the world, including the World Health Organization itself, halted the use, recommendation, and even clinical trials surrounding Hydroxychloroquine. 

The Lancet study as well as another study on the effectiveness of ACE inhibitors published in the New England Journal of Medicine (NEJM) both relied on data from a company called Surgisphere, which claimed to maintain an international database through hospital agreements. 

The studies were eventually retracted as the journals were no longer able to verify the veracity of the data from Surgisphere.

But more interesting than the retractions were the preceding events. Independent researchers, most notably Dr. James Todaro as well as reporters from The Guardian, were responsible for questioning the data, the methods, the sources, and the authors. Independent researchers were able to prove (in less than 2 weeks) that the data of the Hydroxychloroquine study were falsified. 

This was a major blow not only for The Lancet and the NEJM, but also the WHO. How could two of the most prominent medical journals in the world fail in the peer-review process? And how were independent journalists able to do what the most esteemed medical journals and the WHO could not? 

Although the studies were retracted, the damage of the Hydroxychloroquine scandal should not be underestimated. 

The scandal essentially shifted public health focus away from potential COVID-19 treatments in favor of only one single policy in combating COVID: the development of a vaccine.

But perhaps the main contributing factor to the distrust in public health institutions was the shifting narrative regarding vaccines. Initially, public health officials, especially Chief Medical Advisor to the president Dr. Anthony Fauci, touted the vaccine as the solution to ending the Pandemic; that the vaccines would provide protection against COVID-19.

Tens of millions of Americans (some voluntarily but many forced through various policies) received the vaccines, after which the public health experts changed the narrative of the vaccines, saying that although the vaccines do not protect against COVID infections, the vaccines would reduce hospitalizations. 

Now, in a study published in July of 2022, the CDC reports that a third and fourth vaccine dose can provide substantial protection among adults “with healthy immune systems.” This study comes after the New York Times showed how the CDC withheld data regarding vaccine efficacy for those aged 18-49.

Blessing of the Pandemic

The propaganda surrounding COVID-19 policy, and the subsequent public backlash, was a blessing of the pandemic. It is a reminder to public health officials that, no matter your expertise, no one is above scrutiny. The cronyism and propaganda of the FDA, the CDC, and officials at CMS is a reminder that institutions, although they may appear to have the interest of the public at heart, are simply run by individuals who are subject to corruption.

While those institutions have lost all legitimacy in the eyes of the public, we see the public’s trust shift towards newer decentralized media that stood the test of the COVID-19 pandemic. 

It is a scary prospect, as change usually is. 

And of course, it has become more difficult for healthcare practitioners to earn the trust of their patients. However, the public recognizes honesty. My experience in healthcare practice (although admittingly minimal) has shown that patients appreciate honest discussions rather than dogma. 

The decline of public trust should stand as a reminder for us that trust should never be expected from our patients. It needs to be earned.