I have had three different careers that have taught me a lot about problem-solving and decision-making. The first was my physician training. In the course of my training and practice, I learned to analyze lots of data and observations, put it all together and make decisions that included life-and-death situations. That included how to make those decisions quickly when the condition of the patient warranted, and how to make them even when I would have liked to have additional time and data, but the decision could not wait.
As an attorney and when I wrote about and taught Health Law, I learned how to analyze arguments instead of data, and how to weigh their relative strengths and weaknesses.
Then, as the CEO of large organizations, I learned how to make very difficult decisions, for which there were strong and competing arguments for at least two possible options, and for which most often, no one could know what time would reveal to be the correct or best decision.
From more than four decades in these fields, I have learned a lot, but I am just going to offer two lessons because I think the benefit of these lessons could actually get us out of our current mess (more on that below):
- You must correctly identify the problem to be solved. If you solve the wrong problem; it will almost never make the real problem you are facing go away, and it almost always then creates more and new problems.
- If it is a big and complex problem, treat it that way. Don’t reduce it to black and white and make a decision that is to be generalized to all such situations in the future, thus boxing you into a corner and ensuring that you will likely regret and have to contradict that reasoning in the future with a different set of facts.
(If these don’t make sense to you; they will when I put it in context below)
I am going to use a piece of legislation being considered by the Idaho legislature as an example, though there are many such examples I could have selected. It is Idaho Senate Bill 1346 – “Moratorium on certain use of human gene therapy products.”
So, the question I would ask the Legislature is “What is the problem to be solved?” Unfortunately, the answer provided in the text of the bill is ill-defined, sometimes confusing, and sometimes just in error. Let’s look at it:
“To protect Idaho children from the adverse effects of experimental gene therapy and biologic products utilized as immunizations.” I am all for protecting Idaho children, but is that what this bill does? Experimental drugs and biologics (including immunizations) are those that have not been reviewed and approved by the FDA. While experimental, in the U.S., we use these in clinical trials under the oversight of institutional review boards. So, while the bill places a moratorium on their experimental use, it goes on then exempt them from the moratorium for use in “a clinical trial that is covered under an active institutional review board protocol,” which of course, makes no sense because the bill stated the intent was a moratorium on experimental “gene therapy and biologic products utilized as immunizations.” And, of course they have gotten themselves in this knot because they want to consider mRNA vaccines “experimental” to promote anti-vaccine disinformation as part of the justification for implementing this moratorium, but these vaccines were approved five years ago.
There are quite a few things in the bill that simply reflect a lack of understanding of vaccine development, vaccine safety monitoring, cellular biology and immunology, but I have addressed all of those technical points previously, when the precursor to this bill was brought forward last year, so I will not repeat myself.
I use this as an example of my first lesson above:
You must correctly identify the problem to be solved. If you solve the wrong problem; it will almost never make the problem you are facing go away, and it almost always then creates more and new problems.
I will get to what the real problem is and why this is the wrong question next, but first let’s examine why the effort to solve this wrong problem only creates more problems.
I have been a life-long Republican. We used to believe in small government. We certainly used to distain waste and duplication of efforts. This bill would now have the Legislature “reviewing the available safety data” for any products seeking to be exempted from the moratorium, a task that the Legislature is completely inadequately trained or qualified to do. What data do they plan to review? The FDA experts already review this data and make determinations as to approvals so why are we going to build our own costly infrastructure to review drug and vaccine data? Are there now going to be additional reporting requirements placed on everyone who administers vaccines in Idaho to submit data to the Legislature? There is cost that comes with that for providers. How are you going to get the data if you have a moratorium on the use of the products? What prevents the Legislature from expanding this new function and administrative infrastructure to include other vaccines and even medications?
We also used to believe that parents were better suited to make these decisions for our children with their own doctor rather than the Legislature, but we have seen Legislature repeatedly finding ways to insert themselves in the middle of the parent/child – physician relationship. In fact, as an example of just how far my political party has veered from what used to be our foundational principles and values, they now want to take freedoms away from parents while at the same time proclaiming medical freedom in a blatant display of hypocrisy.
So, what is the real problem? I think that reporter Sarah Cutler of the Idaho Statesman got it right in the first paragraph of her article: Can Idaho lawmakers bar children, pregnant women from getting COVID-19 vaccine? https://www.idahostatesman.com/news/politics-government/state-politics/article314941390.html.
“Idaho leaders are vocal about the importance of preserving residents’ ‘medical freedom’: the ability to make their own decisions about their health, free from government mandates or interference.”
Though the bill was offered in the spirit of “medical freedom,” it is actually undermining that freedom. Though the bill is terribly written, we know the real intent because this legislator has said the quiet part out loud: to prevent the use of mRNA vaccines by government mandate and interference. Let’s be clear. There is no one in the state of Idaho that is required to take an mRNA vaccine today and despite this fact, the legislation is labeled as an emergency. This bill, if passed, would simply take the option away from parents who have children with primary immune deficiencies, who are at high risk for severe disease due to underlying conditions, or who live with someone in the household at high risk. It would also mean increased risk to pregnant mothers and their unborn babies.
The whole “medical freedom” movement found its roots in the backlash to mask requirements in 2020 and then vaccine “mandates” in 2021. The issue of when and under what circumstances, if any, masks or vaccines should be mandated is a valid public health, societal and political issue to be debated and decided. However, we aren’t talking about that. Instead, some legislators are going down the path of attacking science and continuing to pass legislation that undermines the practice of medicine, all the way seemingly perplexed at the loss of physicians from our state and difficulty in attracting them. Even here, they are not addressing the real problem of our physician shortage and the loss of physicians from our state. Instead, they believe that the answer is to buy a medical school. Again, if you don’t correctly identify the problem, your solutions are unlikely to make that problem better, and frequently, you will just introduce new problems that compound the problem.
So, in the space of five years, we have gone from people upset about mask or vaccine requirements to deciding that the answer to this problem is to undermine science, undermine the physician-patient relationship, advance anti-vaccine disinformation and sentiment and introduce absolutely embarrassing legislation that won’t address the real problem and will, in fact, just create new ones, for example, the fact that we are now having historically low rates of vaccine uptake and historically high rates of measles outbreaks, with the all-but-certain loss of our country’s measles elimination status in the next month or two. You know what a good way is to prevent disease outbreaks and not have to deal with the issue of masking and vaccine requirements? Get vaccinated! So, the legislature has selected the wrong issue and the wrong solution, which is now just going to aggravate efforts to solve the real problem.
What should have been done? I have been calling for, and even wrote a book about, the fact that what the approach should have been is for our state government to convene a review of our pandemic response to identify what we learned that worked and what we learned from mistakes and then come up with a revised pandemic response plan. Work groups should have been convened to discuss under what situations, if any, mask requirements and/or vaccine requirements should be implemented; who would make those decisions and how long would they be in force for? The legislature is making a big mistake if they think that all disease outbreaks and/or pandemics will be just like COVID-19. There also needs to be discussion about how to plan for and mitigate the next pandemic given that the legislature has taken many of our tools away.
If we bury our heads in the sand about the risks we face, both from natural disease outbreaks and bioterrorism (keep in mind these risks have been greatly increased by our war with one of the largest sponsors of terrorism and by the advances in artificial intelligence) and decide that we will just come up with a plan on the fly, we will be ill-prepared, we will lose many Idahoans, it will interfere with our schools and businesses, and we may again face threats of hospitals being overwhelmed, and we will only have ourselves to blame, though I am certain that those who have worked so hard to undermine our public health infrastructure will not accept any responsibility and just blame whoever is in office as governor.
As for the second problem I raised above – reducing this very complex problem to an overly simple “medical freedom” issue and solution is now going to complicate whoever has to deal with the real issue. If we face a serious threat, one with higher mortality rates than COVID, that is affecting our children and overwhelming our hospitals, I would just ask legislators to think:
- How effective will public health messaging be to advise the citizens of Idaho of what the risks are and how to mitigate those risks during a future health crisis now that so much has been done to undermine the integrity and expertise of public health?
- If we have a novel organism that is highly transmissible and causing an ever-increasing number of cases of serious illness and deaths in children, how do you plan to protect Idahoans now that you have done so much to undermine mRNA vaccine technology. What other technology do you propose that could possibly lead to vaccines being available in under a year while you are hearing from constituents asking what you are going to do to protect their children and keep them alive and in school? Even if you reversed this crazy moratorium, how would you now convince Idahoans to take the only vaccine that we could possibly have available within months to save their children’s lives after all the nonsense you have adopted to scare people about them? How are you going to explain your flip-flopping on these vaccines? This is the problem when you decide to be anti-science – viruses are still going to do their thing and you have now just made their job of infecting people much easier. And, it is only a matter of time, until you will be proven wrong.
Trust me: It is always better to confront the real issues and problems and deal with them open and honestly. I have seldom found that avoiding problems makes them go away or makes the situation better.
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