Thursday, January 21, 2021

JAMES COYNE'S COLUMN

Record Numbers of Californians Die From COVID-19, Surgeon General Promotes Yoga and Screening for Adverse Childhood Experiences

Last week, California’s mass fatality program distributed body bags and deployed refrigerated trucks as makeshift morgues. The Surgeon General mostly kept to her favorite pop psychology topics in media appearances.

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Before she was appointed the first California Surgeon General in January 2019, pediatrician Dr. Nadine Burke-Harris was a charismatic social influencer, a best-selling author, a motivational speaker whose 2014 TEDMED talk was viewed by millions, and the founder and head of the Center for Youth Wellness that attracted considerable funds and endorsements from famous people.

I have been following Dr. Nadine Burke-Harris’s meteoric rise for some time. I had hoped that as California’s Surgeon General, Dr. Burke-Harris would dampen her signature pop psychology message that brought her this international attention.

I wish that the California Surgeon General would not talk so much about toxic stress and about implementing trauma-informed care as a major public health strategy, at least not now, in the midst of a COVID-19 winter. From the point of view of scientific evidence, her approach is making even less sense than it did before the pandemic.

Dr. Burke-Harris could be an effective advocate for curbing the pandemic with an evidence-based public health strategy. She could summon her incredible powers of persuasion and capitalize on the trust that a diverse community has in her. Dr. Burke-Harris could counter the skepticism of many people, especially minorities, about the safety of vaccination and concerns that the medical establishment is using them as guinea pigs. She does a magnificent job of that sometimes, before abruptly shifting back to the topic for which she has the greatest passion.

I do not think many academics savor the prospect of publicly taking issue with Dr. Burke-Harris’s approach or be seen as questioning what she strongly claims is the evidence for it. Yet, when media outlets summon academic and government, public health experts, to comment on the latest COVID-19 news, viewers do not see anything like her public health strategy being advocated. There is an obvious gap between what prominent American and international experts versus Dr. Burke consider an effective public health strategy and what is considered evidence. No one seems willing to talk about the gap.

I am an author of hundreds of peer-reviewed papers, some of them critically relevant to Dr. Burke-Harris’s claims. I do not imagine having an opportunity to discuss or debate Dr. Burke-Harris’s policies with her in public. If I somehow found myself in that situation, I am confident that she would have the audience on her side.

I anticipate that members of the audience would be captivated by her incredible personal story and her emotional appeals and her empty claims for trauma-informed care being grounded in science. I doubt many would listen to any evidence that contradicted her views, no matter how compelling I or other academics believed the evidence was.

When evidence faces off against the power of celebrity status and charisma, the evidence is left lying face down in the street. That becomes particularly important to take into account during a pandemic in which people are dying from misinformation.

In California, the week of December 14, 2020, was horrible beyond what anyone could have imagined a year ago.

The availability of beds in ICUs (Intensive Care Units) at hospitals dropped below 15% in more sections of the state, automatically activating a strict lockdown of surrounding communities.

The release of the vaccine by federal health officials for distribution was announced, but that arrival would not be soon enough to avert an impending disaster in California.

At a press conference, Governor Gavin Newsom announced that the state was experiencing the worst yet surge in cases and death. To cope with the rising numbers of death in Southern California, the governor ordered the distribution of 5,000 body bags and put 60 refrigerated trucks on standby to be ready as makeshift morgues.

The California surgeon general takes to the media to manage the crisis

Dr. Nadine Burke-Harris was already widely sought for expert commentary in media appearances before the presence of the virus was discovered in California. She is a media darling and raises the ratings and numbers of viewers tuning in when it is announced that she will be appearing on a news program.

Her media appearances during the pandemic inevitably involve someone changing the topic at hand into a discussion of trauma-informed care. This is often done by the interviewers directing her into her signature pitch.

The week of December 14, Dr. Burke-Harris’s media appearances included an interview completed by Zoom for a local San Francisco news program.

ABC7 talks to California surgeon general Nadine Burke-Harris about COVID-19’s impact on children

The interview was proceeding with the surgeon general giving a hopeful message about how ordinary people could help control the spread of COVID-19.

”We absolutely can stop the tide, and the way that we do that is through the actions of all of us,” the surgeon general said. “We’re asking Californians to stay home and practice the guidelines that we know help to reduce the transmission of COVID-19 by washing hands, wearing a mask, watching our distance, and maintaining that six feet of social distance from others when we do have to go out for essential reasons.”

While Dr. Burke-Harris was still carrying on in this vein, a subtitle Stress and COVID appeared at the bottom of the screen. Then, the interviewer shifted to familiar ground. The TV station website says:

Yet Burke-Harris warns that some of the lasting impacts of the pandemic on children, from physical and mental traumas to toxic stressors, may not be palpable until years from now.

Other public health experts caution about COVID long term and being vigilant about educating and medically screening persons who had only mild symptoms during their acute bout with the disease. Dr. Burke-Harris’s approach is distinctly different:

She says it is critical and timely that California is releasing a roadmap to address some of these challenges head-ons, and working to minimize potentially negative long-term impacts of COVID-19 on families.

”Manifestations are some of the things that we kind of commonly, might intuitively recognize,” Burke-Harris says, “increased risk for things like depression, or increased risk of substance use or substance dependence. But also some things that many people previously didn’t associate with childhood adversity, things like increased risk for heart disease and stroke, even Alzheimer’s.”

The surgeon general adds that the science shows critical factors in mitigating these traumas include positive family environments and early detection of problems.

On another program, the interviewer eagerly pushed the surgeon general into discussing what parents could do for themselves to protect children from long terms of effects of the virus

Interviewer1: Let’s talk about the pandemic and the stress that it is causing so many people, different levels of stress. and how that is affecting people here in California.

Dr. Burke: That’s right. what we are seeing is increased rates of things like intimate partner violence or increased rates of mental health concerns like depression and anxiety, as well as some increased rates of substance use as well. so that — in fact, my office just put out a report about the impact of stress on health and what we can do to help mitigate the effects of toxic stress.

Interviewer2: What are you recommending?

Dr. Burke: Some of the things we are recommending are things like getting regular exercise. nutrition. Certainly, seeking mental health care if that’s necessary. right now, it is certainly a good recommendation for anyone who feels like they need that. in addition, things like mindfulness, meditation. now is a really good time to go online and access that free yoga class. really practice some of these self-care practices.

Interviewer1: We were talking about some part of your work regarding children and how stress affects them and how we can manifest in different ways in those kids. how it can be a lifetime problem. what about the kids during all of this?

Dr Burke: That’s right. the thing, the key that is the most important for children right now — we know that while stress can affect both our mental and our physical health, safe, stable, nurturing relationships and environments are healing for children. in order for us to do that, I go back to what we were just talking about. reducing our own stress levels. for us as parents and caregivers, we have to put our own oxygen masks on so we can be available to help our kids.

I greatly admire Dr. Sanja Gupta and Dr. Anthony Fauci. I consider them some of the finest heroes of the pandemic, fighting medical misinformation with evidence and reason. I confess to getting choked up and just a bit teary-eyed when I watched them on Saturday morning of this horrible week.

At one point, Dr. Anthony Fauci spoke about having flown up to the North Pole to test vaccinate Santa Claus.

Dr. Sanja Gupta breathed a sigh of relief on behalf of parents and children all over the world: They were now reassured that it was safe for Santa Claus to drop off presents and for the children to open them joyously, for the moment, at least, feeling a bit safer from the pandemic. Ok, a few white lies and a bit of silliness, but I think it is less harmful than making up stuff about trauma-informed care.

In all the many hundreds of hours, that Drs. Fauci and Gupta have spent telling adults and children what they can do to cope with the virus and mitigate its effect on family life, why hasn’t reducing toxic stress come up?

Dr. Burke-Harris is indefatigable in spreading her message. I was surprised at what she was able to get past the editor at STAT+ News, which claims to provide exclusive analysis of biotech, Pharma, and the life sciences. There seemed to be some blatantly harmful pseudoscience, starting with the alarmist title:

Children will pay long-term stress-related costs of Covid-19 unless we follow the science

We should also be concerned about how toxic stress brought on by the pandemic or made worse by it, will affect children’s developing brains and bodies and their future health.

And

Decades of studies tell us that the kind of trauma and stress many children are experiencing during the Covid-19 emergency has the potential to embed itself in children’s DNA, dramatically affecting their brains and other critical body systems and, as a result, their health across a lifetime.

And

We must act now to use the science of early childhood development to address the Covid-19-related stress in children’s and caregivers’ lives. If we don’t, the pandemic will in the short term put millions more children than before at risk for hunger, homelessness, abuse, and neglect. Over the long term, it will lead to more children with developmental delays, asthma, diabetes, mental illness, heart disease, cancer, Alzheimer’s disease, and other poor health outcomes.

I have a question for Dr. Burke-Harris.

Your fine educational record includes a master’s degree in public health at Harvard T.H. Chan School of Public Health. What are the odds ratios associated with childhood adversity with any of the physical diseases you list here?

Should we be alarming already stressed-out parents with worries that their emotional state puts their children’s physical health at risk? Is there any remote chance of parents reducing that risk with any action, even taking up yoga or meditation? Should parents feel guilty if they don’t?

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James Coynehttp://www.coyneoftherealm.com
James C. Coyne is Professor Emeritus of Psychology in Psychiatry at the University of Pennsylvania where he was Director of Behavioral Oncology at the Abramson Family Cancer Center and Senior Fellow, Leonard Davis Institute of Health Economics. He also was Professor of Health Psychology at the University of Groningen, the Netherlands, and has been on the faculties of University of Michigan School of Medicine and University of California, Berkeley. He received a BA in Psychology from Carnegie Mellon in 1969 and a Ph.D. in Clinical Psychology from Indiana University in 1975. Professor Coyne was the 2015 Carnegie Centenary Visiting Professor at the University of Stirling. He is the author of over 400 articles and chapters and has been designated one of the most influential psychologists of the second half of the twentieth century. His diverse interests have included clinical health psychology, mental health services research, and evaluation of depression screening and suicide prevention programs. As a blogger at Science-Based Medicine and Mind the Brain, Dr. Coyne is known for skeptical appraisals of advice gurus misleading consumers with hype and hokum. His activism with colleagues concerning undisclosed conflicts of interest has yielded dozens of corrections to published papers, a few retractions, and the Bill Silverman Prize from the Cochrane Collaboration.

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JAMES COYNE, PHD

James C. Coyne is Professor Emeritus of Psychology in Psychiatry at University of Pennsylvania where he was Director of Behavioral Oncology at the Abramson Family Cancer Center and Senior Fellow, Leonard Davis Institute of Health Economics. He also was Professor of Health Psychology at University of Groningen, the Netherlands and has been on the faculties of University of Michigan School of Medicine and University of California, Berkeley. He received a BA in Psychology from Carnegie Mellon in 1969 and a PhD in Clinical Psychology from Indiana University in 1975.

Professor Coyne was the 2015 Carnegie Centenary Visiting Professor at the University of Stirling. He is the author of over 400 articles and chapters and has been designated one of the most influential psychologists of the second half of the twentieth century. His diverse interests have included clinical health psychology, mental health services research, and evaluation of depression screening and suicide prevention programs. As a blogger at Science-Based Medicine and Mind the Brain,

Dr. Coyne is known for skeptical appraisals of advice gurus misleading consumers with hype and hokum. His activism with colleagues concerning undisclosed conflicts of interest has yielded dozens of corrections to published papers, a few retractions, and the Bill Sliverman Prize from the Cochrane Collaboration.

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