Why do we do the wrong things – or do the wrong things – even though we believe so much evidence?
As someone with a long career in pharmacy, I have seen dramatic changes in public health ethics. But I will not sugar. It often takes years – or even decades – of people dragging, kicking and screaming, finally implementing new and improved social norms.
This time-consuming process seems to be a human error that existed long before the present epidemic and social conundrums. Historically, people do not like being told what to do.
A Remarkable Victory
Attitudes toward smoking have undergone major changes over the past 50 years. Although there has been a gradual decline in smoking, from 42% of Americans in 1965 to young people today, there are still many smokers in the U.S. – and premature death from smoking. Even health-care workers fall victim to this unhealthy and addictive habit.
There was a strongly held view that smoking was a personal decision that good people and the government should close their noses – until the problem was resolved differently with studies showing the harm caused by cigarette smoke. You are welcome to do what you want to do for yourself, but it becomes a horse of a different color when it touches others.
Today, smoking censorship in public is increasingly common. But this change in public behavior did not happen overnight or without hurtful speech. The journey from the first surgeon general’s report of 1964 on smoking and health to the 2006 report of a smoker who smokes cigarettes to this day has been fragmented.
Also on the face was the adoption of seat belts. Seat belts save lives. And many people are now using them because of a warning alarm, car safety marketing, law and data.
This change in behavior, however, has followed a rocky road for many years. In my earlier days, I remember more than once when I got into my friend’s car, put on my seat belt, and was punished for having too little faith in my friend’s driving skills.
Seat belts had to be installed in new cars since 1964 and in New York the first belt use law was enacted in 1984.
In the medical field, much effort has been put into promoting healthy behaviors – diet, exercise, sleep hygiene, adherence to prescribed drugs and vaccination. Clearly, success is included.
Studies have suggested many variations that may be associated with non-compliance with accepted medical advice: age, gender, race, education, literacy, income, insurance copays, the level of medical and pharmacist care – and the obvious old stubbornness. But there is no single, easily justified reason for disrespecting healthy behavior.
For example, properly prescribed cholesterol-lowering drugs called statins can literally add years to the lives of patients by reducing heart attacks and strokes. Even for people with insurance with minimal side effects, 50% of patients discontinue statin treatment within one year of receiving their first course of treatment.
Policies and vaccines provide another window into the disruption of human behavior. Life time in the U.S. We went from 40 years in 1860 to 70 years in 1960. These benefits have led to significant reductions in infant and child mortality due to infectious diseases. Better understanding of infectious diseases and advances in science, vaccines and antimicrobials were the main causes of this dramatic increase in life span.
Common sense alone makes the number of vaccines very clear; How many people do you know who suffer from polio or smallpox? Yet some wise, thoughtful friends, family and neighbors believe that the vaccine is harmless and dangerous. Some believe that wearing a mask is not just a matter of “feeling good”. I believe these contractual beliefs make for better publication and therefore are reported more often than usual, but there is clearly reason to be concerned.
Historically, changes in social behavior that benefit public health occur equally and begin – and have never been sufficiently rapid for people who are attacked before society arrives.
The urgency imposed by coronavirus has actually led to rapid behavioral changes (masks, hand washing, walking) in the U.S. – as scientists study how coronavirus spreads, how dangerous it can be and which groups are most susceptible. But these behavioral changes were not as complete or as rapid as they should have been – or they might have been when they were judged on the best results in other countries.
I am disillusioned with the war between the scientific method and the political ideology when it comes to public health. The idea has never seemed to change so it is very comforting to others – while science is changing as a new discovery removes old ideas or confirms new ones. It is obvious to all who want to listen: virus control and economic preservation are not a thing and / or a choice – they are honest.
At the same time, I am annoyed that the tide seems to be changing. With a better understanding of COVID-19 treatment and a more effective vaccine, “stupid scientists” are finding ground, both on board and in bed. Even prominent theologians rush to the hospital for the best treatments that science can offer when the result of their flawless behavior is getting closer.
But as history suggests, science, no matter how great, is just the beginning of a journey for different people. Ultimately, citizens and the economy will benefit from a shot in the arm.