Aaron Hartman, MD, argues that reopening decisions need wisdom, not just data. Mortality projections have fallen to around 60,000 U.S. deaths through early August. He questions whether narrow experts should drive policy when generalists like physicians, parents, and business owners must live with the consequences.
Chapters
You. It's great to be with everybody this morning. So what I'd like to do is talk about reintroducing ourselves to society, using knowledge and wisdom to apply the information we've gotten. What does that actually mean and how do we move forward? But I first want to preface this with this. These are my thoughts. This is based on my knowledge that I've been collecting since January. Being a physician, being a clinical researcher, I have a clinical research company. Being a small business owner, I've been working for the last month and haven't actually earned anything. I've been working just to keep my own employees employed. Being a parent, I have children, I have family members that are sick, I have elderly parents, both my parents are in their 80s. I'm just like you, I'm just like everybody else. I've got skin in this game just like everybody else. So these are my thoughts based on all of that. So at the level of community, what shall we do? At the level of the locality, what do we do? Level of state and ultimately federally, the people that represent us should represent us. There's a lot of talk about people. We're not in the age of the oligarchs, the monarchs or the kings. Our leaders are not actually our leaders, they're our representatives and they're supposed to represent the will, the people, and also a certain extent to protect us. So the question is, at what point in time, what's the next step? That's the basic gist of all this. So I like to talk about something knowledge versus wisdom. This is the age old discussion, you know, book knowledge versus common sense, you know, so how do we apply, how does this apply in our current situation? What is knowledge and what is wisdom? Well, first of all, knowledge is just the accumulation of information to create a body of data. And that's what we've been doing for the last three months. We've been creating a lot of knowledge. But how do we apply that? Well, that is wisdom. Wisdom is the application of knowledge. So to date, the biggest application has been social distancing. The question is, is that now the still appropriate application with wisdom of the knowledge that we have gained? And that's the question I'm going to try to talk about briefly. One of the issues is we're currently relying on experts for public policy. The question is, are we relying on those who can accurately apply knowledge or, or just those who have lots of knowledge in a limited field? So what do I mean by that? Well, it's kind of like the difference. I'm A medical doctor. So it's kind of like the difference between an oncologist and a cardiologist. So if you have a general cancer, you can go to most general oncologists. Here, where I'm at in the Richmond area, there are some special types of pancreatic cancer where you actually probably want to go to Johns Hopkins, that up in D.C. or Duke, which have really specific pancreatic centers. Now, you would not go to a cardiologist and ask them about your cancer, would you? You would not ask your plumber about foundation work, would you? And so different fields of expertise have different knowledge bases. But the question is, how do we go forward with these experts? Our culture prizes experts, but ultimately, experts have a limited field of expertise, and. And usually we require policymakers or people or other generalists, so to speak. In my field of medicine, I'm a family practitioner. It's my first board certification. So my field of expertise is actually as a generalist, as a purviewer of knowledge in many places, but not a particular specialty in one place. So I think our issue is the issue of the technocrat versus the generalist. Again, the question is, at what point do we use information to then apply it? Because that's all we've been doing right now so far is collecting more information, collecting knowledge. But now how do we, with wisdom, use that knowledge? And we've been holding back, waiting for more information, more information. Now the question is, do we have enough information to move forward? Okay, so for the first. For the first six weeks, for the last six weeks, a lot of y' all have been paying attention to what we've been talking about, and there's been a lot of talk that the numbers might be 10, 20, maybe 50 times higher than what we thought. There's some information actually coming out now that says that is correct as well. For the last four to six weeks, we've been seeing these mortality numbers come down and down. So if you all remember, initially, the concern was 2.434 million Americans might die. Well, that number has been coming down and down and down. And as of this morning, the projections are 60,000Americans might die through August 4th. Now, put that in perspective. In a typical flu season, 40 to 60,000 people will die. The caveat to the caveat is we're talking about a minority of the population has had the disease so far. So the data that up to 250,000 people will die from this is still accurate. It's just we've been flattening the curve, which means we've been broadening the curve. So what we've seen, we've been seeing two phenomena happen. First, the phenomenon within the data that we see saying more and more and more people may have this. So the mortality numbers may be coming down, which is actually true, which we'll talk about in the second part. The other thing about this is that the mortality, which is we were all worried about how many people were going to die. It's come down from the millions to the hundreds of Thousands to now 60,000. So what was the point of the lockdown? It was three major things. One was to flatten the curve, but we broadened it, did not get the curve we expected. Right. The second thing was to allow hospitals to prepare, which we've done. We've done actually fairly quite well. The third one was the thing. I'm sorry. The third thing was to get more data, which we've done. So how do we move forward with all the above? Have we gotten the right amount of all the above? What are our next steps? Do we need more data or do we have enough data to move forward? Those are the questions we all should be asking ourselves, our friends and family and our representatives. How do we move forward? And that's what I want to talk about in part two. Please follow the next link and we'll talk about that in part two.
