Dr Peter Beaver 🇵🇸 Profile picture
Dec 24 11 tweets 2 min read Read on X
1. A friend shared frustration and incredulity that Cardiologists investigating her father’s heart issue during a hospital stay were unmasked. During a SARS2 surge. Cardiologists. Don’t they know SARS2 causes vascular damage?

It occurred to me, this is about culture.

THREAD(11)
2. Culture is irrational. We follow culture even when it contradicts science. Medical professionals are no different. An interesting medical objection to Semmelweis’ infection control work almost 200 years ago was “a gentleman’s hands are clean.” What could that mean?
3. The resistance to Semmelweis was cultural. How so? Medical culture is complex. But fundamentally it’s about helping through diagnosis & medication/surgery. That work is active – it’s about doing, it’s about actively pursuing a goal.
4. But medical culture is also about status. Doctors are socially important. Most of us will sooner or later depend on them and their abilities, to help us, and those we care for. Life and death is everything to us. Sometimes, doctors become like gods.
5. Status within medicine has some association with patient risk. Brain surgery = high risk = high status. Dermatology = low risk = low status.
6. Infection control (IC) is a risk issue. But it can be difficult to know who caused an infection. Which may be some of the reason IC is low status. Also, no one became a great doctor by having no infected patients.
7. The problem with IC is that it’s negative. IC tries to make something not happen. Western culture is a decisive culture. We prefer actively achieving goals to cautiously avoiding pitfalls. If you don’t infect your patients but you don’t cure them either, what’s the point?
8. In Western culture go-getters and risk-takers are rewarded, and their failures are forgiven. They tried to achieve a great outcome. Failure is the sometimes unfortunate price of decisiveness. If doctors are decisive, occasional infections must be forgiven.
9. Having “unclean hands” implies dirtiness, which implies low status. Maybe masking is similar. It implies a doctor could be dirty. Thinking of themselves as possible disease vectors could threaten medical status. Hence, “a gentleman’s hands are clean.”
10. We are deep into irrationality. Doctors won’t mask because it devalues them. Never underestimate the role of ego and appearance in social life. Especially within intensely competitive groups where people must display conformity with group values.
11. CONCLUSION: Whatever the science shows (and the evidence base is quiet corrupt anyhow) for cultural reasons the medical profession are unlikely to voluntarily implement masking with respirators to prevent SARS2 infection. Mandates are necessary.

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More from @PeterJBeaver

Apr 18
Question. Why have many epidemiologists shamed themselves & their profession by minimising SARS2 harms and pushing misinformation?

They’ve contributed to death, ill-health, and the permanent horror of ‘‘living’ with the virus.’

I have theory …
The professional identity of the epidemiologists should have driven them to fight heroically. They did the opposite.

I make no claims about how many and what proportion of epidemiologists. It just seems like too many.
Maybe an answer can be found in the conditions of their work.

Before the pandemic epidemiologists enjoyed high status, income, career security, and a routine of teaching, publishing and conferences.

A disciplined, challenging, but satisfying and rewarding lifestyle.
Read 7 tweets
Apr 16
I keep wondering what pandemic lesson can be drawn from Vaughan’s 1996 ethnographic account of the loss of the Space Shuttle Challenger?
Vaughan reconstructed the native viewpoint: How did NASA engineers & managers make sense of complex technology not performing as expected?
The Challenger burnt up due to heat erosion on the rocket booster O rings. A known fault. Most explanations suggest managers were too concerned with the schedule and organisational reputation. They pushed for launch to save face, save costs, and save time redesigning the booster.
But if managers cared only for reputation, costs, schedule, why launch the Challenger and risk the entire programme?
They did not see themselves doing wrong. They followed a comprehensive risk management process, measurement, analysis, documents.
Challenger was “acceptable risk."
Read 4 tweets
Oct 16, 2022
This is the first study of SARS-2 reinfection.

The risk of at least one sequela at 180 days increased from 135% after one infection, to 211% after two, to 300% after three.

SARS-2 hits you harder each time.

erictopol.substack.com/p/a-reinfectio…
The study is a preprint. Eric Topol: "I have not previously seen any substantive differences from their preprints compared with the final publications."

The median time between infections was: 79 days (1st & 2nd) and 65 days (2nd & 3rd).

researchsquare.com/article/rs-174…
Compared to those with one infection, the risk of all-cause mortality for those who were reinfected (i.e. two or more infections) increased by 214%.
Read 5 tweets

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