The Power of Community

I admit, I’ve been somewhat depressed lately. I find myself glued to the news and social media, obsessed with national and international politics and events, unable to understand the level of animosity and hatred between people. You feel it, too. The national trend toward selfishness and isolation into special interest camps threatens to destroy community. And then I look around Lufkin and refuse to believe all hope is lost.

On May 4, I attended a ribbon cutting for an innovative partnership between Angelina College and Lockheed Martin. Lockheed Martin – a global aerospace and defense company – employs over 500 people in Lufkin, where they manufacture components for several guided missile programs. Working with Angelina College, they created a new manufacturing skills training lab in AC’s Technology and Workforce Center, where students can receive college credit and qualify for an electronics assembler certificate. Certificate graduates will be eligible to follow an accelerated hiring schedule with Lockheed Martin. Those continuing on to get an associate degree have even more options.

The ribbon cutting was a community celebration. Mayor Mark Kicks was there, as well as State Representative Trent Ashby, Chamber CEO Tara Watson-Watkins, AC board members (of which I am one), representatives of the College and Lockheed Martin, and local and regional business development and community leaders. It was a beautiful sight! As Mayor Hicks noted, “Lockheed Martin wins by utilizing the unique training opportunities here at Angelina College to create the best trained employees in all of Lockheed Martin. Angelina College wins by educating workers on the latest in workforce technology.”

What was so heartwarming about the event was that it represented in a concrete way the coming together of community entities and people to accomplish much more than anything anyone could do individually or even as separate institutions. It has been said many times and in many ways that Lufkin is a generous and unique community – one that is full of philanthropic and committed people. We have so much in this county because people get together and make things happen, often with generous support of local foundations. But it is people first and foremost who make it happen.

Take the recent Angelina Benefit Rodeo. According to Chase Luce, President of the Lufkin Host Lions Club, the Rodeo deploys an army of hundreds of volunteers and raises nearly $200,000 to distribute annually for the benefit numerous local organizations, including the Lufkin State Supported Living Center. You can think of many other volunteer-driven arts and civic organizations, museums, churches, the Salvation Army, CISC, the Food Bank, etc., that do great work in our community by helping others and improving our quality of life.

Alexis de Tocqueville, a French aristocrat in the early 1800s, traveled the young United States and collected his observations and reflections in a two-volume tome Democracy in America. In describing what was unique about the United States, he wrote:

Americans of all ages, all conditions, all minds constantly unite. Not only do they have commercial and industrial associations in which all take part, but they also have a thousand other kinds: religious, moral, grave, futile, very general and very particular, immense and very small; Americans use associations to give fêtes, to found seminaries, to build inns, to raise churches, to distribute books, to send missionaries to the antipodes; in this manner they create hospitals, prisons, schools. Finally, if it is a question of bringing to light a truth or developing a sentiment with the support of a great example, they associate. Everywhere that, at the head of a new undertaking, you see the government in France and a great lord in England, count on it that you will perceive an association in the United States.

When it comes to getting something done – especially on the local level – we do not rely on the government when we can take care of it ourselves. Certainly government has a role in society, but so does volunteerism and philanthropy. At a time when we are increasingly depressed about national and world events, it is even more important to focus on what we can accomplish right here at home. Heck, it might just be the key to solving the world’s problems. Attorney and columnist David French modernized and expanded on de Tocqueville’s comments:

“It is here [in community] that we find meaning and purpose. It is here that we build friendships and change lives. … To do the big thing—to heal our land—we have to do the small things. … For those who think and obsess about politics, this shift from big to small is hard. It’s hard to think that how you love your friends [this community] might be more important to our nation [than national political positions, votes, or corporate activism].”

So, what can you do? Find an organization and get involved! Find a place to share your time, talent, and treasure with others. As I often have ended my columns, it boils down to loving God and loving your neighbor. Words are cheap (and meaningless) unless action follows. We cannot “Love Lufkin” – much less our nation and our world – without getting involved right here at home. 

Barn Raisers and Old Coots

I love springtime. Early mornings when I walk my two German shepherds – Zeus and Zoë – the air is still crisp and the sun is just starting to creep up, bathing the quiet neighborhood in shades of yellow and blue. The birds are chirping more. Easter – next weekend –is the ultimate annual marker of renewal (specifically resurrection), and of optimistic hope. Our word for Easter carries a connotation of new birth or dawn. Even the more secular aspects of Easter, like bunnies, eggs, and new clothes, signal the hope of spring. I’m ready! 

But I am tired of pessimistic, contrarian people.

Pessimism just seems both un-American and not Christian. Americans of all stripes are known for being hopeful, industrious people. Ronald Reagan famously described his vision of America as a shining “city upon a hill” – “a tall proud city built on rocks stronger than oceans, wind swept, God blessed, and teeming with people of all kinds living in harmony and peace…” Martin Luther King Jr, in a motivational address at Spellman College in 1960, said, “If you can’t fly, run; if you can’t run, walk; if you can’t walk, crawl; but by all means keep moving.” By moving, MLK was talking about moving toward the Promised Land. Hope and optimism are not the same, but they are related.

Neither Reagan nor MLK were calling for blind optimism. In Reagan’s farewell speech, when talking about his dealings with the Soviet Union and Gorbachev, he also said, “It's still trust - but verify. It's still play - but cut the cards. It's still watch closely – and don't be afraid to see what you see.” Sounds pretty rational to me. And MLK’s vision of the Promised Land endured despite his assassination.

Has our optimism evaporated?

Writing an obituary for optimism in the New York Times, Frank Bruni noted that 71 percent of Americans believe the United States is on the wrong track. This “profound pessimism” and “negative mindset” was present during the Obama and Trumpadministrations alike, reflecting a deep well of anxiety and worry. What a downer.

I think our negativity may reflect less a loss of optimism than a pernicious and growing contrarianism. 

Optimists are by nature not contrary people. They find common ground and work toward the collective good rather than basking in selfishness. They are what I would describe as barn raisers.Contrarians, on the other hand, are not team players. They would never show up at a barn raising with its community first, service-above-self spirit.

Now, as a fourth generation Texan, I am well aware that anindependent, pioneer spirit is part of our collective Texas heritage. But going it alone – ignoring the larger community – can lead to unnecessarily tragic decisions (Remember the Alamo!).

Uber-contrarian people are, by definition, difficult people. (We used to say (s)he’s just an old coot, but that person was probably crotchety their entire life.) In my medical practice, I have learned not to argue with old coots. I will never convince them to change their thinking or behavior. (What do I know about medicine anyway!) Old coots are set in their ways. Facts are inconvenient.

Barn raisers understood the need to wear masks for the benefit of the community. Heck, they may not have had complete faith in them, and very well may have objected to broad mandates. But the contrarian’s attitude was, “Hell, no! Your safety, our full hospitals, none of that matters – only my selfish right to do whatever the hell I please!” Same with vaccines.

I was foreman of a jury many years ago. It was – or should have been – an open-and-shut case. The law dictated that the defendant was guilty by association and the prosecution proved their case beyond a shadow of a doubt. One juror – an old coot – would not budge. Any logical argument from the rest of the jury pool was angrily rebuffed with, “You are just trying to trick me!” He was irrational. He did not have facts on his side, only opinion and emotion. He was wrong, and his stubbornness in not following the judge’s instructions and the facts of the case resulted in a hung jury.

Old coots remind me of Evillene, the wicked witch in the musical The Wiz. A quintessential autocrat, she surrounded herself with sycophants who feared her and wouldn’t tell her what was really happening in the outside world. (Sound familiar?) Evillene sings a song titled “No Bad News” that could be acontrarian’s anthem:

“'Cause I wake up already negative /

And I've wired up my fuse /

So don't nobody bring me no bad news”

Writing for The Atlantic, David French warns, “Don’t for a moment mistake contrarianism for critical thinking.”

“The contrarian [is] both excessively cynical and excessively credulous. He’s too quick to disbelieve one side and too quick to believe the opposite… even when the reality and the morality of the moment could not be more clear.”

French’s comment on critical thinking and contrarianism reminds me of one of my favorite verses in the bible, Romans 12:2:

“Do not conform to the pattern of this world, but be transformed by the renewing of your mind. Then you will be able to test and approve what God’s will is—his good, pleasing and perfect will.”

I read that verse this way: Don’t follow the selfish, contrarian spirit of talking heads on television, but improve yourself by using your brain to dig deeper and learn more. Only then will you be able to tell what is real and what is fake, what is true and what is a lie. God’s will is clear: Love God and love your neighbor.

Newscasts today are all about the latest “crisis” caused by evil opponents on the other side of the aisle, with nary a barn raiser in sight. Old coots, all of them. We need to love God and love our neighbor – together. We have a barn to raise!

Where Does Truth Come From?

 As a physician and Christian, I have been frustrated over the last 2 years with the alarming anti-science response to the pandemic. Two years ago, I shared worst-case predictions of 2.2 million COVID-19-related deaths. I was optimistic that the American people would “flatten the curve” of COVID-19 cases, but the early seeds of doubt and misinformation were already being sown. Ironically, by the time vaccines were available, science had become an enemy. Dr. Anthony Fauci, Director of the National Institute of Allergy and Infectious Diseases (NIAID) since 1984 and trusted advisor to seven Presidents on HIV/AIDS and many global health issues, including the COVID-19 pandemic, became the hated face of science. The loss of trust in science has profound implications not only for the COVID-19 pandemic, but also for healthcare in general.

Francis Collins, a professing Christian who led the Human Genome Project and recently retired as director of the National Institutes of Health, noted that many white evangelicals have been “victimized by the misinformation and lies and conspiracies that are floating around, particularly on social media and some of it in cable news.” Moreover, he said people are dying as a result. “I am just basically heartbroken in a circumstance where, as an answer to prayer, vaccines have been developed that turned out to be much better than we dared to hope for.” Vaccination rates in the US remain stagnant at 65%. Only 47% of Angelina County are vaccinated, with a mere 17% having received a booster, compared with 28% nationwide.

 Some evangelical pastors, whose political power goals – idols, really – appear to be more important than biblical mandates to love our neighbor and care for the least of these, tolerated and often promoted misinformation as opposed to vaccination, often in sync with a deep mistrust of government (except that of former President Trump). This misplaced “faith” won out over science, with the result that far more of our fellow Americans died of COVID-19 than should have – an astounding one million of us so far.

 Denial of the seriousness of COVID-19, promotion of unproven treatments, and rejection of highly safe and effective vaccines are all more common in evangelical Christian circles. Refusing vaccination became the new creed for many – a mark of membership in a chimera Christian nationalism faith, where wearing a mask in church is considered a political statement and not a safety measure.

For those of us who are Christian and work in science-related fields, the chasm that exists – unnecessarily, I might add – between faith and science is perplexing. In 2015 in an article title Are Evangelicals Anti-Science? Sara Kropp Brown noted that “evangelicals are more than twice as likely as the general public (29 percent vs. 14 percent) to say that science and religion are in conflict and that they are on the side of religion” and that “evangelicals are twice as likely as other groups to look to church leaders for answers to their questions about science.” Pandemic politics are certain to have made those numbers worse.

Historically, there was no inherent conflict between science and religion. Scientists have often been men and women of deep faith, including geneticists, physicists, and mathematicians. Augustine of Hippo (354-420 AD) is often attributed with saying “All truth is God’s truth.” The actual quote from On Christian Doctrine (Book II) is right on target in today’s anti-science, anti-vax, misinformation climate:

Nay, but let every good and true Christian understand that wherever truth may be found, it belongs to his Master; and while he recognizes and acknowledges the truth, even in their religious literature, let him reject the figments of superstition, and let him grieve over and avoid men who, “when they knew God, glorified him not as God, neither were thankful; but became vain in their imaginations, and their foolish heart was darkened. Professing themselves to be wise, they became fools, and changed the glory of the incorruptible God into an image made like to corruptible man, and to birds, and four-footed beasts, and creeping things.” Romans 1:21-23

 But we cannot claim “truth” and twist circumstances (sins of commission and omission) to suit our needs. Commenting in Bez & Co, Daniel R. Jones notes, “If we focus wholly on fragmented “truths” without getting around to glorifying God, we’re only exercising our own pride.”

 Reformation theologian John Calvin, commenting on Titus 1:12, put it pretty bluntly: “All truth is from God; and consequently, if wicked men have said anything that is true and just, we ought not to reject it; for it has come from God.” Christians must recognize truth wherever it is found or we dishonor God, even if that truth comes from people you may think “wicked” from across the political aisle, another denomination, or a different race.

 Truth, along with fellow virtues of justice and love, are side casualties in the unnecessary war between science and faith. People of faith across the political spectrum are being manipulated by politicians only interested in power – not truth, and certainly not the gospel’s command to love our neighbor as ourselves. Let’s take vaccination as a moral truth example applied to Philippians 4:8 (parentheses mine):

 Finally, brothers and sisters, whatever is true (vaccines work), whatever is noble (vaccines save lives), whatever is right, whatever is pure, whatever is lovely, whatever is admirable—if anything is excellent or praiseworthy (preventing millions of deaths worldwide)—think about such things.

 This pandemic wave may be dying down, but the truth battle goes on. Science and religion are not incompatible. If the church claims so, she loses credibility. “The culture war is literally killing people,” Collins said. Let’s hope the culture war doesn’t kill the church as well.

Scarlet Letters and Healthcare

When I was in high school in the 1970s, one of our reading assignments was The Scarlet Letter by Nathaniel Hawthorne. Though subtitled “A Romance”, I doubt any high school boy was interested in love per se; rather, we were consumed with the forbidden thrill of sex outside of marriage and the subsequent public humiliation of the offenders – at least the young Hester Prynne in the story, who was both imprisoned and forced to parade in public, forever wearing an embroidered scarlet “A” (for adulterer) over her breast. Nothing like the threat of guilt (or disease!) to keep a young boy “pure,” or so we were raised to believe.

Then there was Mary Mallon, an Irish immigrant and domestic worker and cook in New York City in the early 1900s. She was also an asymptomatic carrier of Salmonella typhi, bacteria that infect the gastrointestinal tract and blood. Seven of the eight families she worked for contracted typhoid fever, which at the time had a 10% fatality rate. She refused to believe she was the source of disease – she wasn’t sick herself, and the concepts of germs and hygiene disease were in their infancy at best – and she continued to work and evade authorities for quite some time. She ultimately was forced to live in quarantine for decades and died alone. She will forever be known as Typhoid Mary.

There have been times in history when labels like “Typhoid Mary” or Hester Prynne’s scarlet “A” have carried an even more sinister meaning. As part of the Nazi extermination program during World War II, Jews were forced to wear a yellow Star of David on their outer clothing with the local language word for “Jew” inscribed in the star. According to the United States Holocaust Memorial Museum, “[The Nazis] used the badge not only to stigmatize and humiliate Jews but also to segregate them, to watch and control their movements, and to prepare for deportation.” For six million Jews and millions of others, including homosexuals and the disabled, that meant death. January 27 was International Holocaust Remembrance Day. I was reminded that day by an old friend of her parents, who were some of the few survivors of Auschwitz. They bore the forearm prisoner identification tattoos they received in the concentration camp as teenagers for the rest of their lives.

Being reared in a conservative and deeply religious community, my formative sense of morals in high school was very black and white. An ethic where actions are only right or wrong leads to equally black and white decisions to punish or not (and, obviously, wrongdoing should never go unpunished!) – in other words, not unlike the Puritan ethic in The Scarlet Letter. There was little room for nuance or grace. 

Healthcare shaming is not unique to Typhoid Mary. Think of the AIDS crisis, when just being gay was considered a disease. Now the COVID-19 pandemic – especially with the ubiquity of social media – has taken public shaming into a new and different realm. To die from COVID-19 now that vaccines are available is practically to have a scarlet “C” affixed to your name and legacy, forcing some families to keep COVID-19 deaths a secret in order to protect them from shame and social stigmatization. Some are separating victims into the vaccinated – worthy of our sorrow – and the unvaccinated – deserving only of disgrace. Websites have sprung up shaming victims with great vitriol. As The Atlantic noted, “With the arrival of vaccines, compassion for COVID-19 deaths began to dry up, sometimes replaced by scorn.” Facebook and Instagram accounts of the deceased and their relatives can be flooded with mocking comments. It is public COVID-19 shaming as blood sport. One family, while acknowledging their loved one who died from COVID-19 was not vaccinated, nonetheless pointed out that vaccination decisions have been quite difficult for some. “We think he was a victim of misinformation,” the deceased’s daughter lamented. She was pleading for understanding and grace.

Unfortunately, we have more of a Puritan mindset all around than we care to admit. Legalism and judgmentalism are increasing on both sides of the political spectrum, with some on the right fighting to have government enforce their preferred religious beliefs and some on the left want to cancel those who they deem to be bigoted. Neither extreme allows dissent or disagreement. Despite our talk of tolerance, we only tolerate that with which we agree. Black and white. Judgment only. No grace. Depeche Mode sang about it in their 1984 hit: People are people / So why should it be / You and I should get along so awfully / So we're different colours / And we're different creeds / And different people have different needs / It's obvious you hate me / Though I've done nothing wrong / I've never even met you so what could I have done. 

We cannot minimize the incredible number of deaths in this pandemic – nearly one million so far – or deny that choices (both societal and individual) have consequences. As I started this column, a good friend’s unvaccinated 20-something niece was on a ventilator with respiratory and liver failure due to COVID-19. She, too, is a victim of misinformation as well as COVID-19, in her case pervasive and false information about vaccine effects on fertility. No amount of gentle urging on the part of relatives could convince her once that doubt was seeded. She was one of the fortunate ones who came off the ventilator and was discharged home, but she still has a lengthy recovery ahead. This family needs prayer and grace, not a scarlet “C.”

Though we are understandably tired of the pandemic – tired of masks, tired of vaccines and boosters – we cannot allow ourselves to tire of compassion, even as we fight to educate and persuade. The Puritans in The Scarlet Letter were so busy judging that they could not feel empathy. Compassion for others forbids us from placing a scarlet letter on anyone’s chest. We don’t know – and don’t need to know – the back story of the injured traveler in the Parable of the Good Samaritan. What was he doing on that road at that time of day? Shouldn’t he have known better? We are simply commanded to have mercy, loving our neighbor as ourselves.

Practicing Grace in 2022

A year ago, we tried to say goodbye to 2020. We envisioned a relatively quick end to COVID-19. The Holy Grail of 2020 – a vaccine against COVID-19 – was found, only to be ignored by so many like an unwanted Christmas present. 2020 did not go away – it decided to reincarnate as 2021. 

Of course, COVID remained the dominant issue this last year, but a capital riot, the Afghanistan exit, and ongoing supply chain issues were not far behind. Crime is on the rise, but it is primarily a wave of violence, not property crime.  Lufkin saw 14 violent deaths in 2021.  

Violence is rearing its ugly head in other ways. Airline passengers have been getting increasingly disruptive for years now, but pandemic restrictions seem to have made things even worse. Eighty five percent of flight attendants said they'd dealt with unruly passengers in 2021, and 17% said they'd been victim of a physical attack.  

You’ve seen it around, haven’t you? This increase in anger and rage. People losing it in the checkout lane, at a restaurant, on a plane. There have always been mean people, of course. But those in customer service are seeing a new level of meanness.  One employee remarked, “People are just — I hate to say it because there are a lot of really nice people — but when they’re mean, they’re a heck of a lot meaner.” 

Verbal violence is all around us and the pandemic has only made it worse. Network and streaming talking heads demonstrate that the exchange of ideas must mean an exchange of barbs, and expressing a political opinion requires a personal attack. We end up raging against cancel culture out of one side of our mouth while simultaneously canceling those who don’t agree with us out of the other, and we argue about who is the bigger hypocrite.  David French writes that the problem of cancel culture is just as much who it empowers as who it attempts to silence.  Cruelty is becoming the norm in public discourse, at least for the loudest and most empowered voices. Nice guys tend to stay silent, afraid of getting hurt. 

As a Christian, I read the Beatitudes  – some of Jesus’ earliest teachings – as a guide for personal discipleship. Regardless of one’s faith, they can serve as a moral compass – a way to extend grace: Blessed are the meek, the poor in spirit, the pure in heart, the peacemakers. All Christians struggle with “walking the walk” – with practicing on Monday what we preach on Sunday. 

As the Evangelical Right activists became increasingly drawn like a moth to the dangerous flame of politics, I believe they began to compartmentalize political morals from personal ones. Otherwise, how could they survive and operate in both worlds without the obvious hypocrisy tearing them apart? The fundamental question is whether or not political interactions should reflect personal moral beliefs. It’s a rhetorical question: they should and do. We cannot truly believe one thing on Sunday and behave differently in the political arena.

Yet some political figures want to sweep the Beatitudes and other teachings of Jesus under the rug, touting a much more strident message. Donald Trump Jr. recently told a conference of young conservative activists the turn-the-other-cheek principles of Jesus have “gotten us nothing.”  As he fired up the group, he acknowledged that “this will be contrary to a lot of our beliefs… but we better be playing the same [cancel culture] game.”  Peter Werner, describing the result of this new political ‘gospel’ in The Atlantic, noted, “If the ethic of Jesus encourages sensibilities that might cause people in politics to act a little less brutally, a bit more civilly, with a touch more grace? Then it needs to go.”  

Whether it is in the political arena, at the airport, or in the corner store, a Christian cannot embody anger and rage in the public arena and expect anything but disdain for the cross around their neck. We can’t chant “Let’s go, Brandon!” at a football game on Saturday and in good conscience sing Amazing Grace on Sunday. As the Christian rock band Casting Crowns asks in their provocative track "Start Right Here":  “What if the church on Sunday / Was still the church on Monday too?” The song goes on to preach: “But church if we want to see a change in the world out there / It's got to start right here / It's got to start right now.”

That change – that move toward authenticity, civility and healing – must start with grace. 

In a recent New York Times opinion piece following the death of Nobel Peace Prize recipient Archbishop Desmond Tutu, who against all odds led the historic Truth and Reconciliation Commission to unify and heal South Africa after more than 40 years of apartheid rule, it was lamented that “In our [United States] culture, reconciliation is often impossible because one side is hellbent on proving that it is right and the other side wrong.”  Civility does not preclude having strong opinions or convictions. Forgiveness does not preclude justice. Love is not weakness.

A practical example: Sometimes all it takes to show grace is taking that extra second or two to think before responding to someone, whether verbally or on social media. (It seems like half of Proverbs is wisdom about taming your tongue.) Online hateful rhetoric doesn’t have to be “liked”, much less forwarded. It’s OK simply to ignore it. Beyond not diving in the social media or political mud pit, how about doing something practical to help out those in your community who are less fortunate? Tim Miller notes that “a culture that does not offer hope and comfort and uplift alongside suffering will not survive.”  

We can make 2022 a year full of grace by loving more, hating less, taming our tongues, and extending grace. Practicing grace takes… well… practice – not just on Sunday, but every day. Let’s all start right here, right now.

Health Literacy, a Pandemic, and the Church

One year ago, a winter wave of COVID-19 cases was starting to surge. The United States had already seen over 250,000 deaths.  The hope of a vaccine was just around the corner. Yet a COVID-19 vaccine misinformation campaign was already well underway.  Now we are approaching a staggering 1 million excess deaths due to COVID-19,  despite having multiple safe and effective vaccines. Why are so many not only not vaccinated against COVID-19,  but angrily opposed only to these particular vaccines against this specific illness?

Also in 2020 – and coincidental to the growing pandemic – UnitedHealth Group issued a report  on health literacy, which is the ability of people to access, understand and use information to promote good health. They noted that health literacy, like other social determinants of health  – social and physical environments, behaviors, access to healthcare, poverty, education, etc. – varies greatly across the country. Maps of health literacy  look similar to maps of county health rankings,  obesity,  heart disease,  poverty,  and education level  – generally worse across the Deep South.

In the paternalistic days of healthcare, health literacy was not even a concept. Patients relied on their physician to make healthcare decisions, trusting that he (almost all doctors were men) had their best interests at heart. Now we “shop” for healthcare as “consumers” in an increasingly transactional relationship. Big Pharma markets directly to the consumer through television, internet, social media, and streaming services. We Google for healthcare information. But are today’s consumer-patients any more educated or more capable of making informed healthcare decisions?

At a very basic level, health literacy must start with actual literacy. Twenty two percent of adults in my county can’t read a newspaper, which is written at around an 11th-grade level.  Add to that the fact that much healthcare information is even more difficult to read and understand, much less process critically. For example, I have otherwise educated patients who cannot tell me the names of the medications they are on and why they were prescribed.

And then along comes a pandemic, a fertile ground for a new, lethal combination of low health literacy and ubiquitous misinformation. A pre-pandemic systematic literature review on the spread of health-related misinformation on social media noted that accurate (often dull) scientific information is easily crowded out by sensationalized news.  The Internet of Everything  promised to help us live an efficient, informed life. Instead, it has produced a far darker reality of unquashable lies and misinformation that, in this perfect storm of pandemic and politics, has resulted in hundreds of thousands of avoidable deaths.  UnitedHealth Group’s report envisioned that increased health literacy might lead to 1 million fewer Medicare hospital visits each year and $25.4 billion in Medicare savings.  No small potatoes. They did not foresee this pandemic, where additional and avoidable COVID-19 hospitalization costs totaled $5.7 billion just from June to August 2021.  

Unfortunately, the evangelical church, of which I am a member, has been on the wrong side of the health literacy discussion, especially as it pertains to the COVID-19 vaccines.  I have written previously about the appalling attempt of many Evangelicals to claim religious exemptions.  Rather than a biblical love your neighbor message, the church – at least the Christian Right version of it – has promoted individual rights and selfishness as the greatest good. Rather than teaching the Beatitudes,  some in the church want to take over the state,  institute a theocracy and claim God’s blessing while doing it. Rather than preaching and being the Good Samaritan  to the pandemic ill, the Christian Right has chosen not only to walk on the other side of the road but to add to the toll of injured.

It is tragically ironic that the self-proclaimed pro-life Christian Right has raged against life-saving vaccination. Ted Cruz, the dominionist darling of the Christian Right,   vilified Big Bird for a “government propaganda” tweet about getting vaccinated.  The church – if it will preach the true pro-life gospel – can’t help but shine a light on this hypocrisy. For so many Evangelicals to fight against protecting and caring for others is not reflective of Christ’s teaching and, at a deeper level, heresy.

When it comes to solving the problem of low literacy and misinformation, avoiding social media and the commentary-based news media is a non-starter. Retracting misinformation is difficult, if not impossible. We have to learn to live with social media and understand that misinformation spreads faster and wider than factual information.  Health care providers must allocate time at every visit to assess what the patient does and does not know and to explain procedures, interventions, and medications in simple, clear language, avoiding jargon, verifying that the patient understands and can repeat back what they were told.  Most importantly, critical thinking should be treated as a core skill in education. We must educate people to be open-minded, to think beyond the noise, to observe and question, to be objective and look for biases, all with humility.

At the end of the day, too many in the Evangelical church allowed fear, misinformation and politics to replace compassion, service, and love. If the COVID-19 pandemic has taught us anything, it should be that loving our neighbors as ourselves is not a hollow commandment;  it saves lives.

The Miracles of Music and Medicine

I grew up in the Friday Night Lights of West Texas in the 60s and 70s, where sports – especially Midland Lee and Odessa Permian football – were king. A preemie who remained anemically skinny all through my school years, I also suffered from an uncorrected lazy eye, which resulted in no central vision in one eye and no functional depth perception. I could not catch a baseball or football to save my life. I truly was the proverbial kid who was picked last for every sports team. Luckily, at the age of seven I was already developing a talent for music. I started taking piano lessons in second grade and have been playing ever since.

Though I excelled academically in high school, I started at Rice University as a music major, though not on piano. I was fortunate to study with the principal clarinetist with the Houston Symphony. Thankfully, I came to several realizations my freshman year: 1) Though I was talented, I was not good enough on clarinet to make the big-league symphony orchestras and make a good living at it; 2) I found playing the same music over and over again a bit boring; and 3) I really wanted to go to medical school. I loved music (and continue to love it, just not playing the clarinet). But I did not want to make music my life’s work. Now, I have the best of both worlds – I have a wonderful career and I get to enjoy music on the side.

The other evening, I was sitting at my piano practicing an arrangement of “O Holy Night.” My daughter, a classically trained soprano, will be singing this at Christmastime and I have the great joy of being able to accompany her. As I was playing – glancing between the written music and my fingers on the keys, listening to the sound fill the room – I had the distinct realization of what a miracle music is. At its most fundamental, the concept that various tones and rhythms can be combined in a non-random fashion and be pleasing to the ear both for the performer and the listener is a mirror of creation. Add to that the genius of the development of various musical instruments and the complexity of composition and performance and you arrive at what can only be described as a spiritual experience where the music and the musician combine in a true act of worship. 

As a pianist, it never ceases to amaze me that I can look at a splotchy group of dots on a page and translate that into an elegant motion of arms, hands, and ten fingers to make music. And when I can make music with others, the amazement and joy is amplified even more.

In 2014, Curt Fenley and I had the pleasure of bringing together the choirs and musicians of New Beginnings Baptist Church, under the musical leadership of Gregg Garcia, and our First Baptist Church for a combined Christmas program. We were without a music director at the time. That Christmas celebration demonstrated another miracle of music – the ability to bring a diverse group of people together for common good and purpose. 

These two churches continue to make music and worship together at Christmas! Under the excellent leadership of First Baptist’s John Lassitter and New Beginnings’ Gregg Garcia, we are practicing for our eighth annual Christmas celebration, to be held on Sunday, December 5th at First Baptist at 6 PM. Our weekly practices together, which can really be described as jam sessions, transport us all away from the daily grind to a place of unity and worship. I hope everyone will plan to attend this impressive Christmas celebration! Canned goods will be gathered in support of CISC as well.

On a more somber note, we are now approaching a staggering 1 million excess deaths due to COVID-19. Nearly 100,000 of those deaths are since vaccines have been widely available. As a cancer physician, it is mind-blowing that COVID-19 is killing more people than cancer. I am heartsick when I hear people I know and love continue to refuse vaccination because of an unrelenting campaign of lies and misinformation, both about the seriousness of COVID and the safety and effectiveness of the vaccines. This paper’s obituary page continues to be filled with tragic and preventable COVID deaths.

In the realm of cancer treatment, hardly a day goes by that patients aren’t clamoring for the latest experimental medicine, desperate to try anything they think will help, regardless of unproven effectiveness and potential harm. How ironic (and senseless) that we have a disease that is killing more people than cancer and people refuse to get a proven safe and effective vaccine. 

I am a rational, logical thinker. That does not mean my heart doesn’t ache when so many are dying for a lie or out of misplaced fear. I tell my reluctant terminal cancer patients who are afraid to take pain medication, once I have counseled them on appropriate use, that there is no virtue and no extra stars in their crown for hurting when they don’t have to. I feel the same way about unnecessary COVID illness and death – there is no virtue there. 

Martin Luther wrote, “My heart, which is so full to overflowing, has often been solaced and refreshed by music when sick and weary.” And so, I sit at my piano, calming my spirit and soothing my weary soul. As we enter the holiday season, I urge everyone to appreciate the miracle of music, yes, but also the miracle of modern medicine. Both have the power to heal. Let us thank God for both.

Happily Ever After

I love fairy tale endings. I am a sucker for the 1997 television version of Rodgers & Hammerstein’s Cinderella featuring Brandy, Whitney Houston, and the incomparable Bernadette Peters. My daughters grew up with that version and we all watched it countless times. Pretty Woman, a different type of fairy tale, has my favorite glamour shopping scene in it. Who doesn’t love Julia Roberts owning Rodeo Drive? And The Princess Bride is simply one of the best movies ever. Apart from a treasure trove of classic quotes – Inconceivable! – the underlying theme of a young couple coming together from different cultures or stations in life and finding true love is heartwarming.

There is nothing like a fairy tale wedding! Remember, though, it really isn’t just the wedding that makes it a fairy tale – it is the promise of living happily ever after! No one sincerely attends a wedding hoping the couple doesn’t make it. Countless books have been written about how to have a successful marriage. Funny, my answer to that is the same general advice I have been giving when dealing with so many pandemic-related controversies: it’s not about you. In marriage, put the needs of your spouse above your own, emotionally, financially, physically. Love in word and deed.

I have been thinking a lot about weddings recently. My oldest is now engaged, and what was a vague prospect of a wedding one day is now an imminent reality. The institution of marriage has changed, though, since I got married.  

Recent data from the US Congress Joint Economic Committee shows that marriage rates hit an all-time low in 2018. Interestingly, the divorce rate actually has fallen by about 30 percent over the last 18 years, speculated to be the result of self-selection out of marriage. According to a 2018 Los Angeles Times article, marriages today have a greater chance of lasting than marriages did 10 years earlier. My generation (baby boomers) married quite young and divorced more (and continue to divorce at higher rates), whereas Generation X and especially millennials are being pickier about whom they marry (or not marrying at all), and tying the knot at older ages when education, careers and finances are on track.

Still, legal, financial, and emotional benefits of marriage – a healthy, lasting marriage, that is – abound. Health insurance benefits, IRA contributions, Social Security benefits, and potential tax advantages often favor marriage. Happily married couples live longer and suffer less from stress and depression.

The Knot Worldwide, self-described as the nation’s leading wedding marketplace and known in the US as www.theknot.com, published the results of a comprehensive survey of Americans married in 2017 that points out many ways marriage has changed over the years. They noted that ceremonies hosted in a religious institution have dropped from 41% in 2009 to 22% in 2017. The same thing holds true in England, where religious ceremonies accounted for 85% of marriages in 1900 but only 49% by the late 1970s and 23% in 2017. The Knot also notes that people are marrying at an older now (around age 30), the number of wedding guests is decreasing (now average 136), and the price per guest is increasing (now average $268/guest). The average wedding cost is now $33,391, excluding the honeymoon!

In our increasingly online society, another trend is notable (and given the sorry state of the US Postal Service, welcome): more couples are creating a personal wedding website (31% in 2017, up from 14% in 2014) and using an online RSVP service (28% in 2017, up from 7% in 2014). During the COVID-19 pandemic, online RSVPs became an essential way of tracking and notifying guests of last-minute venue changes, wedding instructions, or outright cancellations.

As couples are marrying older, the focus of weddings has become more on the guests, making memorable experiences for the attendees and reflecting the personality of the couple. But the fact that weddings are taking place in non-traditional venues does not mean that cultural and religious traditions are not reflected in the ceremonies.

Personally, the move of weddings away from religious buildings doesn’t necessarily bother me. When my wife and I got married, it was every bit the standard Southern Baptist wedding. The afternoon ceremony probably took no more than 20 minutes and we immediately retired to the church parlor for punch and cookies. We had to beg the church not to throw out the Christmas poinsettias until after our ceremony on December 28th because we couldn’t afford other flowers for decoration. There was certainly no sit down dinner, and no dancing or alcohol! Last December, we celebrated our 35th anniversary, so I guess it took. Honestly, hardly a day goes by that Catherine and I don’t tell each other how blessed we are. She truly is my soulmate.

Isn’t that what we want for our children – for them to find a lifelong companion, lover, and friend? Whether my daughters get married in a church or in a barn, at whatever age, I hope and pray they find their soulmate with whom they can grow old together, sharing the ups and downs of life, grateful for the blessing of life and love. The wedding celebration can be whatever they want it to be as long as the significance of the ceremony is not diminished, especially the solemnity of the commitment itself: "To have and to hold from this day forward, for better for worse, for richer for poorer, in sickness and in health, to love and to cherish, till death us do part."

In every generation, the fairy tale magic of love brings people together. That happily ever after part? It may take work, but as Whitney Houston and Brandy sang in Cinderella, “It’s possible!” 

The Deception of Religious Exemptions

 On August 23, the FDA gave full approval to the Pfizer COVID-19 vaccine for individuals 16 years of age and older. This was supposed to be a time of celebration when everyone’s fears and doubts were finally relieved and the lines to vaccination sites extended around the block. After all, more than 200 million doses of the Pfizer vaccine have been administered in the US (not to mention 146 million Moderna doses and 14.5 million J&J doses). Safety and efficacy are proven. Yet only 53% of the population is fully vaccinated and the Delta variant is filling our hospitals and ICUs.

 Incentive payments for vaccination are increasingly common as school districts and colleges encourage vaccination to avoid shutting down in-person learning.   Prominent celebrities and politicians have encouraged vaccination, but others have been vocal opponents. What is apparent is that being nice is not enough to get people vaccinated.

 The FDA’s action lit the fire of vaccine mandates, which were rare when COVID-19 vaccines were under Emergency Use Authorization (most still are). Large hospital systems like Methodist hospital (which mandated vaccines at the end of March) and many major employers from McDonald’s and Walmart to Goldman Sachs have stepped up vaccine requirements. Delta Air Lines will require that employees be vaccinated or pay a $200 a month health insurance surcharge.  Beginning this month, the US military is requiring COVID-19 vaccination to maintain preparedness of our troops, much as they already do for any number of other infectious diseases.

In an article in The Atlantic titled Vaccine Refuser Don’t Get to Dictate Terms Anymore, author Juliette Kayyem says what a lot of vaccinated people are thinking: people who opt out of shots shouldn’t expect their employers, health insurers, and fellow citizens to accommodate them.

 The most vocal demands for accommodation are coming from what historically would have been the least expected place: religious conservatives. Some churches have offered blanket religious exemption letters for those who don’t want to take the COVID-19 vaccination, despite some religious leaders’ prohibitions. One particularly egregious – and frankly, immoral – means to the anti-COVID-19 vaccine end is the use of religious exemptions as a “pro-freedom” political position. This is not the old-style, radical fringe anti-vax movement, which opposes all vaccinations. However, the zeal of these mostly White evangelical Christians is no less extreme. Unfortunately, this segment of the Christian right is a sizable enough minority of the US population that achieving the high rate of vaccination needed to quell this pandemic has become a herculean, if not impossible, task.

True religious exemption requests are based on sincere religious beliefs. It defies credulity that in this era of declining church attendance and doubt that God even exists, sincere religious exemptions are suddenly in vogue. Religious leaders across the spectrum – Pope Francis, the Dalai Lama, the archbishop of Canterbury, the presiding bishop of the Episcopal Church, the leadership of The Church of Jesus Christ of Latter-day Saints, pastors, rabbis, imams, Hindu leaders, Buddhists, Sikhs, even Jehovah’s Witnesses – support vaccination.  Apart from all major religions looking askance at religious exemptions for COVID-19 vaccination, one leading bioethicist commented that most of the purportedly religious opposition to COVID-19 vaccination is not sincere; rather, it is “just a way to get out of having to take a vaccine.”

 Up to 2019 – prior to the pandemic – medical exemptions for vaccinations were rare. For example, the US median non-medical exemption rate among kindergartners was 2.0%. If the COVID-19 religious exemption rate was anticipated to be a mere 2%, we would not be talking about it. No matter the rate, Erwin Chemerinsky, dean of the UC Berkeley School of Law, argues that policies requiring vaccination against COVID-19 need not include, and should not include, exemptions for those who have religious objections to vaccinations. “No one, in practicing his or her religion, has a constitutional right to endanger others,” he writes. United Airlines apparently has taken that to heart, amending their mandatory vaccination policy to say that those granted religious exemptions will be placed on temporary unpaid leave and only allowed to return to work “once the pandemic meaningfully recedes”.

 It should be clear: If you have never refused a vaccination on religious grounds – if you are vaccinated against measles, mumps, rubella, diphtheria, tetanus, shingles, hepatitis, or any other infectious disease – then suddenly in 2021 you decide you don’t want to take the COVID-19 vaccination, that is not your religious belief. It is your political opinion. There is a huge difference, and the latter does not qualify you for exemption. And lest anyone think vaccine mandates are unconstitutional, think again. The US Supreme Court decided for vaccine mandates way back in 1905.

 There is a misplaced rage among too many Christians – yes, rage! – disingenuously cloaked in a dubious religious liberty narrative against safe, proven, life-saving vaccines. As political commentator, attorney, and Christian David French writes, “The very moral framework of millions of our fellow citizens—the way in which they understand the balance between liberty and responsibility—is gravely skewed.” The title of that recent column by French says it well: it’s time to stop rationalizing and enabling evangelical vaccine rejection. Amen to that. “But my freedom!”, some are screaming, as they want to claim vaccine mandates are the (evil) government’s way of suppressing the church. French thoughtfully argues there is no religious liberty interest in refusing the COVID-19 vaccine.

 As if we need reminding, liberties have limits. We are at a point where our “self”-centered society falsely believes that individual rights trump our responsibilities as citizens of our great democratic constitutional republic. All citizens – especially true Christians – should be doing everything in their power to care for the health and safety of others in this pandemic. That includes getting vaccinated. It is our civic and moral duty, if we would acknowledge it. Attempting to claim a religious exemption for the COVID-19 vaccines is, frankly, an egregious example of biblical bad fruit.  Let us all produce good fruit.

Anger in the Time of Coronavirus

What an emotional roller coaster the last year and a half has been! The pandemic and the election have been a double whammy on our mental health. Religious leaders are seeing a lot more anxiety and depression in their congregations. FiveThirtyEight notes that hatred now dominates American politics. Though we are learning more about potential long-term physical consequences of COVID-19 infection, I fear anger may be most damaging and lasting side effect of the pandemic.

I’m generally not an angry person. But there is a pervasive anger I suspect most of us are experiencing. It catches us off guard. By the time we are aware of it, we are about the explode. The triggers may be different for each of us. For some (like me), it is the failure of the country to get behind the greatest vaccine development and distribution effort in the history of the world. For others, it may be the political fallout of a lost election, or the decline of the church, or systemic racism, or immigration. Our anger has been whipped into a frenzy by presidents and politicians, by news organizations and social media. Our collective and individual anger switches are on an ever-shortening fuse. This is not healthy. Anger is tearing us apart from without and within. 

For example, vaccine hesitancy is the lead story in much of the news right now. The phrase vaccine hesitancy is kind. It is a gentle way of referring to the ever-hardening decision by far too many to refuse to save lives – theirs and others. Honestly, hesitancy describes very few now and grossly mischaracterizes the selfish and vehement opposition of too many to getting vaccinated – kamikaze cultism, as this paper called it. Vaccination rates have plummeted. The Delta variant is on the rise as a result. In states with low vaccination rates, more than 99% of COVID-19 deaths over the past six months were among unvaccinated people. Virtually all current COVID-19 hospitalizations and deaths in the United States are preventable.

We continue to give people the benefit of the doubt, hoping that the truly hesitant will step into the light, when the dark void of lies and misinformation has swallowed so many. Fear of the Delta variant may now be convincing some holdouts to get the jab. On the other hand, those falling on the straw man sword of freedom and personal responsibility will get to enjoy the consequences of their choices, which increasingly may mean wearing masks at work, regular nasal swab testing (isn’t that fun!), or even loss of employment. Some will die. Freedom to choose is a wonderful thing.

Does that sound cynical to you? Yes, I am cynical. And, as I said, angry even. As a cancer physician, I have determined that a healthier emotional reaction to the unvaccinated would be more like my compassionate-yet-uncompromising reaction to smokers, who often have a similar “personal rights” reaction to smoking restrictions (and who can be “addicted” not only to smoking, but also to the misinformation and rationalization that misplaces and overrides the very real health dangers that demand a broad societal response). One person I attempted to talk to about getting vaccinated said, “It is scary that we would capitulate to forced mandates. You agree with this one, but may not agree with the next. You may be very thankful later that people like me will stand in the gap regardless of the social stoning we are experiencing.” Yet very few of the anti-COVID-19 vaccine zealots are true libertarians. They are much more likely to view COVID-19 vaccine refusal as a statement of political identity and a test of party loyalty. And that social stoning? Self-inflicted wounds are an affront to the true coronavirus martyrs – those who lost their lives through the inaction of others. 

Don’t get me wrong – every COVID-19 death is tragic, regardless of the circumstances. My anger at the situation must not be seen as a lack of compassion for the person. Our healthcare system and the providers in it will do everything they can to care for those who are suffering and dying from COVID-19. 

The vaccine isn’t of the devil, folks, and it isn’t the mark of the beast, either. Ah, but anger is, including mine. When Jesus sent his apostles out to spread the gospel message – literally the good news – he didn’t tell them to get angry when the message was rejected. They were to shake the dust off their feet and move on. Some people laugh when I suggest it is a Christian duty to get vaccinated to help others, as if the Good Samaritan story has no modern pandemic equivalent. We should be protecting our neighbor, not infecting them. I’ve shaken off a lot of dust lately. Yet, I will continue to spread the good news that vaccines save lives.

Whether vaccines or elections, critical race theory or immigration, politics on the left or the right, we cannot let the sun go down on our anger. The antidote to anger is gratitude and love. It is hard to remain angry when you are counting your blessings and serving others. I’ve said it many times before, but the response of those claiming to be followers of Christ – and I count myself among those – should be to love our neighbor. 

Are you suffering from debilitating anger, anxiety, or depression? Seek help. The Burke Center is here for you. Reach out to them at https://myburke.org or by calling their 24-hour crisis hotline at 1-800-392-8343. 

Cognitive Dissonance, Trust, and COVID-19

Most of us have had our lives disrupted in some way as a result of the COVID-19 pandemic. As difficult as job loss and economic upheaval have been, it is the loss of life that is most tragic. Between March 1, 2020, and January 2, 2021, the US experienced 522,368 excess deaths, an incredible 22.9% more than expected. Though the vast majority of these excess deaths were directly COVID-related, deaths from other causes (heart disease, Alzheimer’s, and diabetes, for example) were also increased. Total COVID-19 deaths have now exceeded 600,000. Yet to hear some talk, you would think the coronavirus was nothing more than an excuse for the government to infringe on individual rights.

As the pandemic surged on, all anyone could talk about was controversy surrounding pandemic-related measures (masking and social distancing), COVID-19 interventions (hydroxychloroquine and bleach come to mind), and ultimately vaccinations. As illness and deaths mounted, an insidious combination of mixed messaging, misinformation and politics perpetrated an ironic and sinister distrust of science and healthcare.

It used to be common to joke about how little we trusted politicians. How is it that now we trust (some of) them more than scientists and doctors, even when it comes to science and medical information? There is cognitive dissonance here: A) Doctors are some of the smartest people around (so I’ve heard), and they are exquisitely skilled at preventing, diagnosing and treating illness; and B) Politicians are self-proclaimed experts at viral transmission, disease severity, drug effectiveness, and vaccine necessity.

Cognitive dissonance – holding on to conflicting or inconsistent positions – is not new in health-related matters. Smokers demonstrate it all the time: A) Smoking is bad for me; and B) I smoke. There is a fundamental conflict between what smokers know or should know (based on scientific facts) and what they do. Smokers resolve this internal conflict by trivializing (smoking is not that bad), rationalizing (at least I eat healthy and exercise), or trying to change or deny the facts (smoking didn’t cause my heart disease, COPD, or cancer). Deflecting blame for bad outcomes is common. The hard road to resolving the cognitive dissonance associated with smoking is to change behavior and quit.

I don’t mean to pick on smokers. Nicotine is addictive and quitting is quite hard. Every time I stop for a Ray’s bacon cheeseburger with onion rings or get an iced cookie from Confections (two of my favorite local eateries), I experience a bit of cognitive dissonance myself. I rationalize, I trivialize, I deny that it may be unhealthy. With diet, however, one can assess whether the hamburger or cookie is an occasional treat or a bad habit. The cognitive dissonance surrounding COVID-19 (and especially vaccines) is more problematic.

As a physician, I often do not know whether my patients believe what I say and will act on what I recommend. I strive to be seen as a trustworthy authority. Lack of trust – in me or the system – has consequences. Healthcare system distrust is associated with lower COVID-19 vaccination rates, especially in minority communities. In my field of oncology, distrust affects outcomes across the breast cancer continuum. Even before COVID-19, trust in doctors had plummeted by 75%. (The internet has turned everyone into an expert.) The odd anti-vaxxer, for example, used to be an easily dismissed anomaly. Now, a crippling vaccine hesitancy risks preventing COVID-19 herd immunity. The consequences could be devastating, as virtually every COVID death going forward is preventable.

Let’s consider: A) COVID-19 vaccines are readily available, wildly effective, very safe, and completely free (all verifiable facts); and B) Less than half of the United States is fully vaccinated. Cognitive dissonance. This isn’t just a problem in the United States. How are people responding to this inconsistency – this disconnect – between what we know (again, scientific facts) and what we do? It is the same playbook we saw earlier with smoking – that of trivialization, rationalization, and flat-out denial. Add in conspiracy theories and “it’s like choosing from which side of the flat Earth we’re going to jump off,” according to an obviously exasperated Dr. Luana Araújo, a Brazilian infectious diseases physician.

The apostle Paul struggled with the inconsistency between beliefs and actions in his letter to the Romans, admitting he doesn’t do the good he wants to do; rather, he does what he knows he shouldn’t do. Can we amen that? Paul even calls himself a wretched man as a result. That’s cognitive dissonance! Paul was instructing on the spiritual condition and the nature of sin and grace. I’m simply trying to get people to use common sense.

Where do you stand with COVID-19 vaccinations, and why? Seek the truth rather than trying to bend the facts to your preference. We have a misinformation pandemic where lies propagate across the internet further and faster than truths. What is the source of your knowledge? Is it science experts and doctors, or politicians promoting their own self-interest and conspiracy theories? Second, be willing to eat a little humble pie. Don’t throw logic and facts out the window in order to cling to pride or party. If you haven’t been vaccinated yet, you are allowed to change your mind! Making the wrong choice about vaccinations during this pandemic (especially with the newer, more virulent Delta variant on the rise) can have deadly consequences.

Hopefully we can get back to trusting the healthcare system and doctors more. Are we perfect? Of course not. We must earn your trust. I know I strive every day to do just that.

Vaccine Passports Are Coming

Like it or not, vaccination passports are coming. Before we go too far, let’s be clear: the federal government has no plan – and really no ability, at this point – to mandate, create, and verify a nationwide passport confirming anyone’s vaccination status. Though privacy issues are cited as the main reason, the more practical reason is that the United States (unlike other countries) does not have a national healthcare system that is responsible for registering people for and administering COVID-19 vaccinations. In other words, the federal government doesn’t know who has been vaccinated. 

A vaccine passport is really nothing more than proof of COVID-19 vaccination. Many businesses, organizations, and even countries are starting to require proof of vaccination as a form of pay to play. Honestly, that is nothing new.

In 1986, I journeyed to rural Thailand to work in a Baptist mission hospital for two months. I was required to get a yellow fever vaccination and carry proof of vaccination with me – a yellow fever vaccine passport, if you will – in order to travel. In 2021, for those ready to visit European Union countries, tourists from “safe” countries will be allowed in – as long as they can show proof of vaccination against COVID-19. Greece is open. France, Spain, Germany, Italy, and Croatia, among other countries, are opening up again soon or have already opened up. Proof of vaccination is the surefire ticket, though entry with a recent negative COVID-19 test or proof of recovery from COVID-19 in the past six months may be possible in some circumstances.

Educational institutions are looking closely at vaccination requirements as well. My alma mater, Rice University in Houston, Texas, recently announced that all members of the Rice community are expected to return in person for the fall semester and all students who come to campus are expected to be fully vaccinated before school starts. The list of colleges and universities following suit grows daily. This really shouldn’t surprise anyone. Colleges have required vaccination against infectious diseases like meningitis, measles, mumps, and rubella for years. Why not against COVID-19 in the middle of a pandemic? The Supreme Court affirmed compulsory vaccination laws way back in 1905 and specifically affirmed proof of vaccination laws for public schoolchildren in 1922, both cases dealing with smallpox. 

Texas Governor Greg Abbott (R) issued a politically motivated executive order on April 6, 2021, “prohibiting state agencies or political subdivisions in Texas from creating a `vaccine passport’ requirement, or otherwise conditioning receipt of services on an individual’s COVID-19 vaccination status.” The order also prohibits organizations that receive public funds from requiring proof of vaccination “in order to receive any service or enter any place”. Abbott’s executive order trying to prohibit vaccine passports is only effective as long as vaccines are administered under an emergency use authorization, and it excludes nursing homes, state supported living centers, assisted living facilities and long term care facilities. 

The question of whether colleges, businesses – anyone – can require COVID-19 vaccination when the vaccines are under emergency use authorization (EUA) status is quickly becoming irrelevant. First, Pfizer is applying for full FDA approval of the Pfizer-BioNTech COVID-19 vaccine. Moderna plans to do the same. Both vaccines are highly effective and safe. Second, the Equal Employment Opportunity Commission (EEOC), announced on May 29, 2021, that U.S. companies can mandate that employees in a workplace must be vaccinated against COVID-19. The Houston Methodist Hospital System, one of the most respected healthcare systems in the world, has mandated their employees get vaccinated or face termination. Ninety-nine percent of their 26,000 employees have been vaccinated, but 117 staff are suing. Based on the aforementioned legal precedent and the EEOC pronouncement, the suit should get thrown out.

Short of mandates, employers can choose to offer incentives to employees to get vaccinated. Dollar General, for example, offers employees an extra four hours of pay if they get vaccinated. Incentives extend to the general public as well. By now, most have heard of the Krispy Kreme reward, where those who can show proof of vaccination can get one free glazed donut a day. My waistline is glad there is no Krispy Kreme store near me. Vaccination incentives, from donuts to lottery tickets to permission to attend in-person, live events, or even raising health insurance premiums for those not vaccinated, are mentioned favorably in respected medical publications like the New England Journal of Medicine. People magazine even came out with an article on how to get promotions, prizes and freebies with a COVID-19 vaccine card. 

Ultimately, the goal is to encourage those who may be sitting on the fence to go ahead and get vaccinated. Some diehards may bristle at the thought of vaccine passports and being required to get vaccinated – “Don’t Tread on Me” and all that. They would do well to remember that rights have limitations and choices have consequences. Those opposing vaccination must ask themselves if it is really worth not being able to fully participate in an open economy, much less risk losing their job, just to forego a highly safe and effective jab. Between mandates and incentives, not to mention basic moral and civic duty, refusing COVID-19 vaccination is an increasingly senseless and expensive hill to die on. As for me, I’ve got my passports – the official one and the COVID-19 card – and am ready to travel again!

Rosie the Riveter and Dolly Parton

The time was the early 1940s. America was at war. The aircraft and munitions industries heavily recruited women to take up important jobs in support of the war effort. In 1942, artist J. Howard Miller created the iconic, yellow background “We Can Do It!” poster of Rosie the Riveter, dressed in blue and wearing a red bandana, flexing her arm and looking straight at you. There is a power of iconic images like Rosie the Riveter to motivate people and to effect change.

We are engaged in battle again today, this time against a deadly virus. The nation needs a modern-day Rosie to recruit for the COVID-19 vaccine war effort. Who better than Dolly Parton, who not only rolled up her sleeve to get vaccinated, she donated $1 million to Vanderbilt early in the pandemic, which helped lead to the Moderna vaccine. To be precise, Ms. Parton did not have to roll up her sleeve when she got vaccinated. Her sparkly “cold-shoulder” top allowed her to get her shot without a wardrobe adjustment. Now it’s a fashion trend. I’d like to nominate her for sainthood.

I’m not sure even a Saint Dolly could increase vaccination rates enough to reach herd immunity. Vaccine hesitancy is astonishingly high. Though political leanings play a role, it is certainly not as simple as Trump supporters versus all others. Jonah Goldberg, writing for The Dispatch, noted that when the COVID-19 pandemic began, very few conservatives and Republicans disagreed that the government had a role to play: “pandemics, like wars, are supposed to be tackled by the government.” Even the staunchest libertarian – focused on “autonomy and political freedom” – can understand that preventing the spread of communicable disease is a necessary and worthy role of government, even as certain means to control disease (government shutdowns, for example) are questioned.

But the libertarian forfeits their principled position when their personal right to act becomes a belligerent and ignorant – not to mention community-harming – stand. So went Custer. Some are even wearing the decision not to be vaccinated as a badge of honor.

When you combine a growing libertarian streak with the individualism and sense of invincibility common among Millennials (aka “Generation Me”), it is easy to see why vaccination rates trail off dramatically the younger you look. A cynical person might suggest that Millennials just want the excess number of Baby Boomers to die from COVID-19 so they don’t have to support them in retirement. Plus, they’ll get their inheritance sooner. After all, those old people were going to die anyway. (Yes, I have heard it said on more than one occasion that COVID-19 didn’t really kill older people; they were going to die anyway.)

Young adults aren’t invincible, despite podcaster Joe Rogan telling them they don’t need to get vaccinated. (He later walked back that comment, stating, "I'm not a doctor. I'm a f---ing moron.") It sells more papers (or internet and social media ads) to play up the rare vaccine side effects than to tell the stories of young people who suffered or died from severe COVID-19. But those stories are out there. Serious cases are on the rise in younger adults, creating a create a "reservoir of disease" that eventually "spills over into the rest of society." Without a doubt, President Biden should order US military personnel to get vaccinated. Our military must be fit at all times.

I have had many thoughtful discussions with people who have not yet gotten vaccinated. Outside of conspiracy theories, I have yet to hear an argument that is not based ultimately on either fear or self-centeredness. The most sensible argument made against the COVID-19 vaccines is that we don’t have enough long-term safety data. (The original argument was that they were developed too quickly, but that was a false argument from the start. Years of advance research laid the groundwork for COVID-19 vaccine development.) But with hundreds of millions of doses given – and only extremely rare serious side effects seen – the safety of the vaccines being given in the United States is unquestioned. Pregnant women can get vaccinated, and there is no evidence any of these vaccines affect fertility.

True anti-vaxxers are a lost cause. They are crazy. You can’t reason with a conspiracy theorist. But there are many honest folk who have heard so much misinformation that they either don’t know what to believe or just can’t get rid of their doubt. These are the people who need to step up and take responsibility for more than just themselves. Otherwise, we are left with pure selfishness. Rosie would not approve.

Though vaccine hesitancy is seen across the nation, rural and conservative areas are the worst. Once again, as with almost every health metric from smoking to obesity, from education level to income, rural America comes in last. One may have different political beliefs and still unite in caring for the poor, the vulnerable, the least of these. Love and justice demand it. The New York Times argues that vaccine hesitancy isn’t a knowledge problem; it is about gut beliefs or “moral intuitions”. Vaccine hesitancy among evangelical Christians is pathetically high. What amazes me is that the folks who claim the moral high ground and purport to be concerned for the eternal welfare of others apparently don’t care enough about others’ lives here on earth to take a simple shot.

So, for the freedom loving, anti- big government individualists out there, hear me: You can mistrust authority and love your neighbor. You can hate Dr. Fauci and still protect your grandmother. You say you love your country? Then protect her and end this pandemic. It boils down to “where your treasure is”. Is your core motivation the “moral preference for liberty and individual rights”, or is it “love your neighbor as yourself”? Maybe one choice honors both. Rosie the Riveter rolled up her sleeve. So did Saint Dolly. You should, too. 

OpenNotes Mandate: A Box of Chocolates

Sometimes cans get kicked so far down the road that we forget about them. Such is the case with a 2016 federal Health Information Technology mandate known as the 21st Century Cures Act Info Blocking Rule, advocated by a non-profit organization known as OpenNotes. The Final Rule ostensibly is designed to give patients secure and free access to almost all of their electronic health information (EHI). The deadline for implementation of the “Information Blocking” rule was set for last November, but was delayed at the request of the American Medical Association and other medical organizations until April 5, 2021, primarily due to the COVID-19 pandemic.

 

The rule states that eight types of clinical notes can’t be “blocked” and must be made immediately available to patients: consultation notes; discharge summary notes; history and physical; imaging narratives; lab report narratives; pathology report narratives; procedure notes; and progress notes. Some notes, such as psychotherapy notes and information “compiled in reasonable anticipation of, or use in a civil, criminal or administrative action or proceeding,” are exempt.

 

It is certainly not a bad idea for patients to have access to their medical records. The OpenNotes organization promotes research showing that when health professionals offer patients and families ready access to clinical notes, the quality and safety of care improves, costs are lower, and communication and engagement are enhanced.

 

So how does this OpenNotes concept of immediate access to medical records work in my clinic? Though my Cancer Center electronic medical record (EMR) has allowed patient access via an online portal since 2014, I can count on one hand each year the number of patients who actually care to access their chart. In a rural, less educated region where computer savvy and broadband access are limited – especially in a typically older cancer patient population – patients often don’t have the means or the knowledge to look up their records on a computer. Many don’t even have a smart phone.

 

Still, some patients are quite computer literate. In the best of circumstances, I have patients who come from other hospitals – facilities in the Texas Medical Center in Houston, for example – who can access outside lab and x-ray reports on their iPhone while sitting in my office. That can be such a timesaver, especially when calling physician offices and medical records departments is a hit-or-miss, time-consuming operation. Fax machines, an unreliable relic of the last century yet still the main means of sharing documents in a HIPAA-compliant fashion, are too often offline or busy.

 

But this OpenNotes mandate is like Forrest Gump’s proverbial box of chocolates: “You never know what you're gonna get.”

 

Scott MacDonald, MD, an internist and electronic health record medical director at UC Davis Health, notes that there are sensitive issues, such as with adolescents and reproductive health, where "we know that some parents have sign-in information for their teen's portal." With clinical notes now on full display, potential problems "may be out of our control."

 

To illustrate, I have a patient who recently had a biopsy that I ordered. Realistically, I would expect a preliminary result in perhaps 48 hours. Often, particularly detailed pathologic studies can take days longer, sometimes even a week or two. My standard practice is to have the patient come in to discuss pathology results as soon as I receive a printed, finalized copy from the pathologist. In this instance, the patient called my office in a panic the very next morning after his biopsy because he received a text notification on his cell phone – thanks to the OpenNotes mandate – that a new medical record had been uploaded to the EMR access app on his smart phone. He clicked on the link to find his pathology report stating he had cancer. Not knowing how to interpret a pathology report, he assumed from what he read that he had four different types of cancer. Ironically, I was not yet able to access that very report on the hospital’s system. In other words, the patient – and only the patient – had access to some very scary information without the benefit of the customary and compassionate face-to-face discussion where we could explain what it all meant. The doctor-patient relationship was utterly – possibly dangerously – circumvented.

 

Information Technology has become the tail that wags the healthcare dog. Global IT spending is expected to exceed $4 trillion in 2021. The most common complaint I hear from patients about other physicians’ offices is that the doctor never looks at them – their back is turned to them as they face a computer instead of the patient, often charting so-called “quality” indicators that have nothing to do with the current patient visit. I do not have a computer in my exam rooms for this very reason: the patient is here to see me, not the back of my head. Granted, that is a luxury many providers don’t have, given time constraints and crowded schedules. Regardless, providers must remember to keep the patient literally in front of them.

 

How we chart – what language and phrases we use, how we describe complex concepts and procedures – may change as a result of the OpenNotes mandate, as we now are speaking not only to our medical colleagues but to our patients as well. Some would argue – rightly, I believe – that we should have been talking to and writing for our patients and not above their heads all along.

 

Will the OpenNotes mandate end up being a positive thing for patients and doctors? On the whole, I believe so. I appreciate when patients comment that they have read their records. They ask more questions, which lets me know what I have explained well and what needs work. An engaged patient is a good thing. But with every box of chocolates comes the unwanted dud (anything with coconut, in my opinion). We must anticipate these unintended consequences and be proactive with our patients, always educating and ever ready to comfort. Our role as healer may not have changed, but how we do it always will.