Thursday, November 6, 2014

The Self-Destructive Power of Cynicism

Cynicism appears to have replaced idealism as America’s defining characteristic.  So many of us just don’t trust the government, scientists, the clergy, journalists, business CEOs, labor unions, lawyers, or just about anyone for that matter, to say or do the right thing.

Two years ago, the National Journal reported that as a consequence of the Great Recession, “Americans are losing faith in the institutions that made this country great.”  The Pew Research Center finds that public trust in government has “reached an all time low;” in 1958, a whopping 73% of Americans expressed trust in the federal government; by 2013, only 24%, said they  trusted it much of the time.

The Gallup organization has surveyed the public over the past four decades about how much trust they place in various institutions and professions.  The Economix blog has converted Gallup’s data into an interactive graph that tracks changes in opinion over the decades.  “Click on almost any category charted in the graph,” Catherine Rampell wrote for Economix, “and you’ll see that confidence has generally been falling.”

Even the medical profession, which has relatively enjoyed higher “confidence” ratings and hasn’t suffered as steep declines as other sectors, does not fare so well when compared to other countries. Harvard researchers found that “based on data from an international health care survey, the United States is near the bottom of the list when it comes to public trust in the medical establishment”—ranked 24th in the world, on par with Croatia.

The public’s lack of trust in science and scientists is particularly alarming.

Take the Ebola controversy.  The National Journal’s Ron Fournier says that “the scariest thing about Ebola” is what it says about trust in U.S. government and institutions.

“Once again,” he observed, “Americans are reminded of the limits of U.S. social institutions—in this case various state, local, and federal government agencies and private-sector health systems that responded to the Ebola crisis slowly, inefficiently, and with a lack of candor that Americans, unfortunately, have come to expect.”  Such lack of faith in leadership, he noted in a follow up commentary, has led to “outrageous” policy outcomes, like mandatory quarantines of nurses and doctors.  Why is this so?

“The governors don't trust the scientists who oppose a mandatory quarantine for health care professionals exposed to Ebola,” writes Fournier. “The White House doesn't trust the governors. The governors don't trust the White House. Doctors don't trust nurses. Nurses don't trust hospital administrators. Hospital administrators don't trust federal officials, and the Feds don't trust them. Nobody trusts the media. The public trusts nothing. This rampant lack of faith in each other and in our institutions is how we got to a place where the state of New Jersey is holding a courageous 33-year-old nurse hostage.”

As ACP noted in its own statement, “mandatory quarantines for asymptomatic physicians, nurses and other clinicians, who have been involved in the treatment of Ebola patients, whether in the United States or abroad, are not supported by accepted evidence on the most effective means to control spread of this infectious disease. Instead, such mandatory quarantines may do more harm than good by creating additional barriers to effective treatment of patients with Ebola and impede global efforts to contain and ultimately prevent further spread of the disease.”  The CDC, the Infectious Diseases Society of America, and Dr. Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, are all in agreement with us.

The problem is that Americans don’t trust what the experts tell them: 71 percent of them back mandatory quarantines of health professionals that treated Ebola patients in West Africa.

Or take the growing numbers of Americans who refuse to vaccinate themselves or their children. A recent study found that “In some areas, nearly one out of five children has not received their recommended vaccines. The consequences are serious not only for those unprotected children, but for the rest of society as well. ‘Herd immunity’ is threatened as more and more parents free ride off of the community's dwindling immunity, and outbreaks of diseases thought to have been conquered have already occurred.”

Opposition to vaccinations actually increased when anti-vaccine parents were given accurate scientific information about them, another study found.  “Researchers focused on the now-debunked idea that the vaccine for measles, mumps and rubella (or MMR) caused autism. Surveying 1,759 parents, researchers found that while they were able to teach parents that the vaccine and autism were not linked, parents who were surveyed who had initial reservations about vaccines said they were actually less likely to vaccinate their children after hearing the researchers messages.”

Or take climate change.  The Washington Post reports on a study that confirms that 97% of scientists agree that human activities are causing the planet to warm.  A new report from the United Nation’s Intergovernmental Panel on Climate Change concludes that "If left unchecked, climate change will increase the likelihood of severe, pervasive and irreversible impacts for people and ecosystems.”  The World Health Organization concludes that global warming will affect “the social and environmental determinants of health – clean air, safe drinking water, sufficient food and secure shelter.  Between 2030 and 2050, climate change is expected to cause approximately 250,000 additional deaths per year, from malnutrition, malaria, diarrhea and heat stress.  The direct damage costs to health (i.e. excluding costs in health-determining sectors such as agriculture and water and sanitation), is estimated to be between US $2-4 billion/year by 2030.  Areas with weak health infrastructure – mostly in developing countries – will be the least able to cope without assistance to prepare and respond.”

Yet too many Americans are disbelieving of the scientific consensus: Gallup reports that more than four out of ten say that the seriousness of global warming is exaggerated.

If we allow the cynics to carry the day, we will all pay a steep—and perhaps lethal—price.

If we don’t trust the scientists, doctors, and public health agencies on Ebola, then what will happen if we have a flu pandemic that threatens millions?  Will we tune out the recommendations from the experts about what science tells us needs to be done to limit spread of the disease? How many will die as a result?

If we don’t trust scientists, doctors, and government agencies on the safety and effectiveness of childhood vaccinations, won’t we be condemning thousands of kids to die from diseases that could have been prevented?

 If we don’t trust the scientific consensus on health consequences of global warming, aren't we putting millions of lives around the world at risk of harm and even death from diseases, unsafe water, poor air, insufficient food, and insecure shelter?

British historian and author Kenneth Clark once said that “We can destroy ourselves with by cynicism and disillusion, just as effectively as by bombs.”  I fear that the rising tide of American cynicism may be bringing us closer to that day.

Today’s questions: Why are Americans so cynical? Are you one of them?  Do you agree that cynicism, and especially distrust of science and scientists, are putting us at risk?


Harrison said...

Fear and hate seem to me to be the driving forces of self destruction, but I'm willing to accept that cynicism is playing a big role.

I think that there is political advantage for some to stirring the fear and hate pot.

People hate President Obama. I live in a district won on Tuesday by Duncan Hunter. He got some headlines by saying he knew for sure that ISIS had crossed the border. Of course it is nonsense. I suspect that the Congressman even suspects it is nonsense, but prefers to believe that it is not. It plays into his hands.
I meet every day with people who believe that the IRS targets conservatives. They believe that the White House orchestrated the Benghazi attacks. They are sure that undocumented people from Mexico are getting government benefits that are costing us a lot in taxes. They are sure that there is a plan that the President is aware of that will allow terrorists with brown skin sneak across the Mexican border. They absolutely do not believe that human activity has anything to do with climate change, and there are some who see this as a religious prophecy, with President Obama obviously playing the role of the Anti-Christ.

This is mainstream in this area.
Duncan Hunter and Darrel Issa are in side by side districts and they win by painting these images.

It is truly sad.

There is fear under the surface.
FoxNews is considered not only a legitimate news source, but the only news source.

The New York Times recently reported on a piece of science, where the brains of people are monitored with a functional MRI as they are shown images that are disgusting. The correlation they were able to make is the brains that reacted most to these images were the brains of people who self identify as conservative.

Fear and Hate come to rest in the political fortunes of one of our major political parties. The conservative party.

Stir up fear and aim it at the 'others.' That is how you get soldiers to fight and kill people they don't know. They don't see them as human.

I think that drives political dialogue now more than cynicism.
I think it always did.
That is where our major wars came from.
That is where the communist scares of the 50's came from.
That is where the 60's came from.
And that is driving the distrust of the President, along with the isolationism against immigration, and terrorists who are half a world away, and ebola which threatens Sierra Leone and Guinea and Liberia, but not the US.

I don't think the climate debate falls into this though.
That is misinformation from oil companies who stand to profit.
Although they are probably driven by fear of economic disruption as much or more than by self interest.

So maybe that too is fear.
And hate follows. If you are afraid, there has to be something to hate.


Harrison said...

I think I made it seem like I believe that the only way to be a Republican is to be afraid and hateful, and possibly racist but certainly isolationist.

I know for sure that isn't true.

I have a lot of respect for many Republican politicians.
I think Mitch McConnell at his best is a gifted politician who can do the right thing and has a lot of power to do so.
I can certainly understand supporting him and in fact from the clips I saw of his opponent, I would have had a hard time supporting her.
Ed Gillespie in Virginia is a well spoken and reasonable man.
By all accounts Mr. Hogan who is now the governor of Maryland is an excellent politician and very reasonable.

But then there is Senator Cruz. Far from reasonable.
My neighbors Mr. Hunter and Mr. Issa are also far from reasonable.
Mr. Gohmert in Texas is close to crazy.
Scott Walker in Wisconsin is about as disingenuous as people get.

There is reason to be hopeful.
But it depends on the Republican party pulling itself together.


PCP said...

A few observations.

1) the increase in cynicism appears directly proportional to the rise of government's role in everything. One does wonder if it is that like everywhere it's been tried that gov't does promise a whole lot more than it can deliver and thus by its actions erode trust in the institutions and professionals that its mandates are directed at?

2) Politics has gotten very partisan. However one viewing of that press conference by Pres. Obama yesterday should make any american cringe, no matter what his/her political leanings. Here is a president with a very low approval rating, whose party just got a shellacking the sequel at the polls, saying he heard the electorate but also the 2/3 that did not show up.
Any reasonable person should have a gut check about his style. Mind you this is the same president that said with bravado in his first term that elections have consequences, and if you disagree with me campaign and win an election, really Mr President?
The republicans have had more than their fair share of criticism for their part in the disagreements. However Mr Obama is so clearly playing to his base rather than interested in any agreements. I've noticed that about his style in the past and it is just more obvious now. To his credit President Clinton had that capacity to negotiate that Obama seems to clearly lack. For anyone feeling this is a partisan view, I direct you to Chris Matthews the MSNBC hosts frustrated rant yesterday about this topic.

3) In a lot of these issues, money had taken center stage and people seldom are made to understand that a few people/institutions are above that. Certainly someone like Dr Fauci should command that type of moral standing, yet in our system there is no clear captain of the ship. There are too many cooks in the kitchen, and even Govs. Christie and Quomo want to be cooks. This is not dissimilar to what happens at a ground level when primary care is fragmented in such a manner that, everything from retail clinics, to ERs, to ANPs, to PAs, to everyone else starts to lay claim to being the patients Primary care Doctor. Certainly they can all play a role but policy should never obfuscate the roles. Yet that is precisely what has been happening due to lobbying.

DrJHO7 said...

Why are Americans so cynical? Are you one of them? Do you agree that cynicism, and especially distrust of science and scientists, are putting us at risk?

There is no place for Cynicism in the physician office or exam room. The nature of our work as physicians demands that we reject the temptation to fall into cynicism, nihilism, negativism, and other'isms that can get between the physician and the patient and the fundamental nature of that interaction which is proper diagnosis and treatment of the patient. Patients may be cynical in their attitude or countenance, but as physicians, we are to check our baggage at the door, and proceed with the task at hand.

As an internist, I am something of a skeptic. My mentors taught me to be skeptical of the ER physician's assessment, the admitting diagnosis the patient came to the floor with, the benefits of a drug touted by the pharmaceutical company, or the benefits of a dietary supplement touted my its marketer. However, skepticism, or being a careful and shrewd diagnostician, should not be confused with cynicism.

Cynicism is antithetical to professionalism. As physicians we should reject it. If our pt's are cynical, it is our responsibility to try to educate them. If they do not respond well to our efforts to educate them, they may have to learn the hard way re: decisions they make as a result of a lack of trust. Trust, as with respect, is generally earned. Our society, in general, has become mistrusting. As physicians, the way we can regain some of that is through consistent professionalism. In this way, we can better serve our patients, and they may have better health as a result.

ryanjo said...

I can't characterize Americans' mistrust of our institutions as cynicism. That implies that the mistrust is undeserved. But we all know it is not.
Our leaders regularly lie, pander to big contributors, grant special privileges to big union bosses and corporate bigwigs, and smear opponents while campaigning.
As PCP says, this trend corresponds to the consolidation of power over every aspect of our lives by government and large corporate entities. Companies overcharge, underdeliver, let our personal data be stolen and kill us with defective cars and poisoned food. And our elected officials act as ennablers by saving GM to sell us defective cars.
As physicians, this has resulted in us becoming scribes, bean counters and enforcers for government and insurers. And we have been sold the idea that we are the problem.
And why would the public trust a doctor who returns from West Africa, gets a fever and goes bowling? Or a nurse who arrives in Newark with a fever and responds to isolation by hiring a lawyer instead of thinking of her fellow citizens. Or another nurse who flies home after contact with an Ebola patient despite a "voluntary quarantine". But why should these people obey "the authorities", which have misinformed us & misjudged every step.
Keep empowering people who you can't look in the face, and who don't answer to you, and this will only get worse.

Anonymous said...

But when medical "leaders" such as the ABIM push/require a costly process such as MOC and clearly benefit from it, that generates a significant amount of cynicism from the typical practicing physician. It is easy to see how cynicism can result from "well-meaning" requirements without a thorough understanding of unintended consequences.

Unknown said...

Harrison: Please give us citations, not your editorial opinion. For Lois Lerner:
And for the ACA:
I was roundly censured on this board 3 years ago for implying that politics ruled Obama and the Democrat Party. I would appreciate your comments based on fact. Thanks.

Unknown said...

And 1 more for Harrison:

Unknown said...

Whine about FoxNews but refute the facts:

Harrison said...

You want me to cite opinion pieces to refute opinion pieces?

Lois Lerner took the fifth in front of Congress.
She has a defense team and it is an ongoing trial.
I don't think that we know facts.
But Congressman Issa has not tied the Ohio IRS office decisions and track record to a larger IRS problem and much of it has to do with faulty interpretation of tax code for organizations claiming non profit status.
It is a complex legal battle.

Facts are hard to come by.

I think that the burden of proof for Mr. Hunter is on Mr. Hunter's claim that ISIS fighters are crossing the Southern border.
The fact is that people in authority deny it as pure fabrication.

Mr. Gruber in my mind is not really bringing any news to the table about the politics behind Obamacare.
It was a difficult to write bill that was done in a hurry while there was a Congress that could act.
And it acted.
There have been legal challenges all the way to the Supreme Court, and there is going to be another soon, and we will see if the 5 conservative justices are willing to strip health benefits from millions by choosing a very narrow interpretation of a law that passed Congress.

But despite what Mr. Gruber says, and despite any background about how the legislation was passed, the fact remains that it was passed by the Congress of the United States, and signed into law by the President of the United States, and upheld as constitutional by the Supreme Court of the United States.

Those are pretty strong facts.

Do you need a citation?

And I hope I didn't berate your opinion.
I value opinions.

Harrison Robinson MD

Belasarion said...

I wandered in here while link chasing but find it interesting that you agree with the National Journal's report that we have lost trust in science, "as a consequence of the Great Recession."

That is ridiculous and lazy to boot. People lose confidence when confidence is betrayed. I have lost faith in the departments of government as, one-by-one, the individuals chosen to administer them, often with no obvious credentials, engage in some kind of untoward shenanigans.

In respect to Ebola, the need to fulfill some moral obligation to the countries in West Africa seemed to be taking precedence over purely medical judgments.

Then there were the daily public alterations in guidance in protective measures and description of the risk. Even now, we seem to have adopted measures somewhat different than other organizations with more experience with Ebola. I'm not a doctor but I noticed.

As far as climate goes I find the people who make claims about global warming entirely discredited. The "97% consensus" paper has been withdrawn and yet you are citing it.

It wasn't very long ago at all that there was no such thing as a climate scientist. Every one of those people came from somewhere else and there are thousands of scientists, some 9000 of them with Phds in STEM who disagree with the very small number of scientists in climate.

What I know how to do in my specialty is measure things. I understand and I disagree with how they are measuring and adjusting temperatures from ground stations. It's not much but it is what I know. It doesn't take a lot of that to destroy your credibility.