More than 1000 Americans have died from swine flu, and worldwide, swine flu deaths near 5000. Meanwhile, the headline in yesterday's New York Times painted a somewhat disconcerting picture: "Shortages and Confusion in Flu Fight." But of course, skeptics abound, from Bill Maher on the left (sort of) to Glenn Beck on the right (sort of). So in the midst of this muddle, what's the right public-health strategy?
One answer, as we shall see, comes from the history of technology, which can eventually be made to work. With enough patience and persistence, even the greatest national endeavors can succeed.
But first, we should pause over the good news about swine flu, starting with the fact that we have the vaccine at all. Thanks to improved science, including the decrypting of the human genome, we have dramatically accelerated the vaccine-making process, getting done in weeks that which used to take months--and, of course, couldn't have been done at all just a few decades ago.
But of course, that doesn't explain away all the SNAFUs. And some have leapt to make their case that governmental incompetence is endemic, even about epidemics. "Life Under Obamacare?"--that was the acerbic headline of a pungent editorial in yesterday's The New York Post:
Many say that's what Americans will face if the government runs the nation's health-care system, as Democrats in Washington propose. And that suggestion is certainly gaining credibility, based on the way Washington is handling today's flu-vaccine program. ...
If federal bureaucrats can't handle this program -- despite having warned about it since last spring -- how on earth will they manage a trillion-dollar comprehensive health-care system, if Congress enacts ObamaCare?
Here at Serious Medicine Strategy, we won't defend everything that the Obama administration has done on the swine flu issue; on "Fox News Watch" today, I noted that the White House seems more interested in attacking its enemies than attacking public health problems. It would, in fact, be nice to see the President spending as much time on the health of Americans as he is spending on Afghanistan, or cap-and-trade, or other issues with considerably less impact on American lives. Yes, it was nice that the President last night declared swine flu to be a national emergency, bu we might review the first nine months of his presidency and fairly ask of the President: Swine flu ranks exactly where on your list of priorities?
Still, here at SMS caution against the tempting conflation between public health efforts (almost all of which carried out by professionals, whether or not the commander-in-chief shows any interest) and the push for national health insurance (almost all of which is being carried out by politicians, pundits, and ideologues). Despite the bad name that "national health" is giving to "public health," we tend to think that the government, working with private industry, and all the various stakeholders, should be doing more, not less. We should seek to power through the problem, as part of our overall Serious Medicine Strategy.
Those thoughts were underscored for me as I was reading Antony Beevor'snew book,D-Day: The Battle For Normandy, specifically, the chapter on the American assault on Omaha Beach, memorialized so harrowingly and dramatically in the 1998 movie, "Saving Private Ryan." Those portions from Beevor's excellent book remind us that every technology is usually in a process of improvement--much needed improvement. A case in point is aerial bombing.
As Beevor describes it in his book, 329 American heavy bombers flew over Omaha beach in advance of the amphibious assault, dropping 13,000 bombs. And what was the damage done to the German targets? Zero. That's right, none of the bombs hit the beach defenses. As one observer said of the failed bombardment of the Germans, "That's a fat lot of use--all it's done is wake them up."
Beevor summarizes: "The US Army Air Corps had made wildly optimistic claims about their 'precision bombing.'" Gens. Bernard Montgomery and Omar Bradley "seemed oblivious to the fact that the heavy bombing formations remained incapable of dropping the majority of their load within a five-mile radius of their target."
The Normandy campaign abounded with such tragic mistakes--hundreds, if not thousands, of Allied soldiers were killed in "friendly fire" incidents, including Gen. George Patton's right-hand man, Lt. Gen. Lesley McNair. And much of the air power in the whole war was wasted, on one bad plan or another. But that's the nature of war: Like anything else, it takes experimentation to figure out what works and what doesn't work. And that experimentation, bloody as it might be, is the only way to do it--you can do a lot in a laboratory, but for those inventions to do their job, they have to be introduced into the battlefield.
And of course, air power was probably the single most effective and decisive weapon in World War Two, especially if one includes the B-29-dropped atomic bomb as part of air power. But still, the fact remains that airpower over-promised and under-delivered on so many occasions during World War Two--and in just about every war in the last 90 years. Most notoriously, the perceived failure of air power to change the course of the Vietnam War haunts American policymakers to this day. (There is a substantial school of thought that holds that the US could have won in Vietnam by dropping more bombs, on top targets, as we did in the "Christmas Bombing" of 1972, but of course, we'll never know.)
But by now, after decades of relentless efforts at improvement, and billions or even trillions of expenditure, we have gotten to the fact that we can drop a bomb--or a cruise missile--onto just about any target anywhere, with precision accuracy that is really precise. As we have discovered, such precision doesn't guarantee that we can kill, say, Osama Bin Laden, because he's a moving target, but if we knew exactly where he was, we could blow him up within minutes. And that's quite an achievement--a reminder that if we try hard enough, we can solve these problems.
And so back to public health. If we can precision-strike military targets, we can also precision-strike medical targets. And most Americans would probably be glad to see us try just as hard on medical targets as we do on military targets.