Thread by @usnehal

In the U.S. we have a "tough guy" attitude towards health that is seen in many outcomes across #populationhealth metrics. This false dichotomy between economy and health is not new. We have poor sick leave or parental leave. Healthcare a "benefit" of employment.

Not sure why my #MedTwitter peers are so shocked by the way the U.S. has responded to a preventable #publichealth crisis

US docs, selves, want individualism & personal financial gain
over
systems for a common good

@Health_Affairs on AMA vs Medicare

healthaffairs.org/do/10.1377/hbl…

The “government can’t tell me what to do for the protection of others - I know best” is a common thread in U.S. history & culture of rugged individualism

I mean, this is a country that started by throwing others’ property in ocean to protest government. history.com/topics/america…

Then add the growing distrust of science.

So when you post that meme of “don’t mistake your google search for my degree” it may make you feel better to snark but it only reinforces the idea that scientists are elitist “vs” the average Joe.

nature.com/articles/nbt11…

This makes the argument that Americans have always been distrustful of science. There is a strong case to be made for that.

If you look at cultural values and historical patterns, predictable.

This is the ivory tower vs regular American divide.

zocalopublicsquare.org/2019/07/19/dis…

I see people constantly making the analogy to seatbelts being common sense & universal. Clearly they’re not aware of the fact that New Hampshire does not have a seatbelt law.

“Live free or die” is the state motto.

Rejects public safety regulations.

nhpr.org/post/you-asked…

In fact there was this brutal piece (which I do NOT agree with) by esteemed “father of #EBM”: denies evidence to justify #preventivemedicine in comparison to curative medicine. This was cited to me by an anti-WHO ob/gyn I encountered on #MedTwitter

cmaj.ca/content/167/4/…

In fact this internal opposition within #healthcare and #medicine vs #preventivehealth

is precisely why the @AmerAcadPeds was formed in the first place - child/family minded physicians walked out of the AMA over #publichealth legislation

jamanetwork.com/journals/jama/…

claim: curative health more “proven”
than preventative health

motives not necessary so pure

does not hurt that there is much greater financial incentive to treat via surgery or medications

than to prevent
prevention: 💰 for society
cure: 💰for 👨‍⚕️ 🏥

nytimes.com/2020/05/15/us/…

Or take Wakefield - we wonder why we have hard to control rogue physicians

Not U.S. but same #academic culture
-Reward if in “right” journals
-Staff bullied: unethical testing of their children at bday party
-COI not reported
-etc

=Cult of personality

https://t.co/F1ZPn1tWBs

If we did not make special allowances for people we deem:
to be “important”
bringing in 💰
good for reputation

if we were less elitist, hierarchical

then physicians & academics might have already earned & established credibility with public
on common good
when a pandemic hits

We repeatedly exclude the very people who are closest to communities (=hubris) & most aware of what the average person values & thinks

WOC clinicians’ authority questioned more - frustrating.. yet gives us more insights to actual thoughts people have

https://t.co/kYOTXP2SkB

When Minnesota needed to address antivaxx targeting #refugee communities - spreading anti-science fear to already traumatized populations (with high rates of #PTSD)

MN used true #communityengagement methods with good results

statnews.com/2017/05/08/mea…

mnmed.org/MMA/media/Minn…

What is missing from so-called “#culturalcompetency”

recognition that the U.S. itself is several nations & cultures

Americans from one part of the country or socio-economic strata do not know how to #communicate to other Americans

=#SciComm failure

businessinsider.com/the-11-nations…