Emergency Powers: [10] Yes, the medical narrative is political.
From my April 2022 paper COVID-19 Emergency Powers: The New Zealand State, Medical Capture & the Role of Strategic Ignorance
Chapter 10.
Lacking resourcing, expertise and stewardship, New Zealand will remain impotent to future claims of private and public institutions with either political and/or financial conflicts of interest.
In a recent presentation, an MBIE staffer stated that New Zealand’s research, science and innovation system ‘has been largely apolitical’. The production of science that draws attention to environmental drivers of human and environmental health harms is directly political. A culture that positions technology – including medical treatment – as the answer to social problems, jointly delegitimises those that might contest this perspective, while displacing and depoliticising the drivers of disease which are powerfully, undeniably political.
The weight of knowledge that supports a medicalised perspective encourages economic conflicts of interest because medicalisation is closely tied to drug development, approvals and regulatory decision-making. The same institution with a partnership with Pfizer will be unlikely to encourage research that is critical of Pfizer. In addition, the sheer weight of economy and innovation oriented, or ‘market’ science, dwarfs independent (publicly funded, common good) science, capturing publication and funding channels, and this perpetuates scientific cultures that reinforces a medicalised perspective. Innovation-centric health research shifts the scientific gaze away from the drivers of disease, making it difficult for advocates to fund scientific data that might provide evidence to drive regulation of a harm, or pull a product from the market.
These institutional practices produce not a health system, but rather, reinforce a chronic disease-based medical system. In New Zealand today, public health advocates, scientists and doctors would be largely out of health-policy scope if they researched the overarching environmental and institutional drivers of disease – the health effects of environmental (rather than behavioural) factors, such as ultraprocessed foods and obesity, or scientifically researching molecular level effects of vitamin D. It would be similarly antithetical for a researcher to explore the propensity for unknown quantities of the spike protein to replicate inside the cell, and persist and damage the epithelium and induce clotting at a higher rate than the naturally acquired spike protein.
They might get funded once, but long-term research would be extraordinarily difficult, and their reputations could be at risk. Exploring adverse reactions is unwelcome in the current political environment, and Kevin Drew and Sarah Donovan have argued for increased transparency in public health, stating
‘Public health can be upfront and transparent about the decisions made, the values they are grounded in, and any uncertainty around those decisions, so that people can have more confidence in vaccine policy.’
And adding:
‘… public health advocates can do more to engender trust. They could work to ensure that pharmacovigilance activities around vaccinations are rigorous, which may require actively seeking out concerns about vaccine reactions rather than passively receiving them, and that people’s concerns are taken seriously and not dismissed. To engender trust, communication across divides should be fostered, rather than using or accepting polarising rhetoric. And as public health researchers we surely must not shy away from scrutinising vaccine policies, but we are best placed to take on the duty of interrogating vaccine policy and the efforts made to gain high levels of vaccine coverage (Dew, 2018), to ensure they are robust, fair, and convincing.’
‘Market’ science, lacking balance by the public sector inevitably fractures the fundamental infrastructure (p.271) that democracy rests upon because there is no intellectual space for ‘market’ science to be challenged.
Democracy requires that decisions are made in the public interest, and that decision-making will be accountable and transparent. However, private, unpublished industry science is routinely prioritised and selected above and beyond any review of the published literature. It is therefore given asymmetrical weight in policy, that extends far beyond any independently funded, published, and peer-reviewed studies. Science is harnessed for economic gain, and disproportionately - for private, corporate, economic gain.
Sen and Nusbaum’s capabilities approach, which drew attention to the often invisible (social, cultural, economic and environmental) barriers that make it disproportionately difficult for low-income groups to achieve well-being – applies here. With a health system that is principally medicalised, when a pandemic arises – following Sen and Nusbaum, there is no capacity – no expertise, no field of research nor quorum of scientists - that is sufficiently authoritative and buffered from potential political backlash – to advocate for ethics-based health protective policies.
New Zealand’s sole ‘health’ activity (OIA request ref: H202110708) has been to update nutrition guidelines, however, exactly how low-income groups will afford the recommended diet, remains out of scope.
On the Unite Against COVID-19 Campaign site, healthy habits were connected to hygiene management, and no information relating to nutrition or diet were provided.
Health is not primarily determined by access to medication – the determinants of health are often intensely political. Our health is powerfully and predominantly socially determined.
Health is a function of environmental factors including culture, socio-economic status, public interest regulation and access to life-sustaining resources.
Yet the social determinants of health keep being excluded from government policy. Medication can improve quality of life, but medication can also result in the perpetuation of illness as it enables symptoms to be ignored, and can dually produce illness through the collateral effects of polypharmacy and adverse reactions. The cost of multimorbidity is super-additive – more illness escalates health costs and therefore profits.
As this paper has discussed, poverty drives obesity and obesity is a powerful predictor for vulnerability from infectious disease, including COVID-19. In New Zealand, 16% of children have obesity, and obesity is associated with a wide range of undiagnosed comorbidities in adolescents.
Covid-19 restrictions may have increased obesity. After old age, the biggest driver of risk that an individual will be hospitalised or die from COVID-19 is their health status – whether they are profoundly obese, have cardiac, neurological disorders and/or multiple health conditions.
Indigenous populations including New Zealand Māori are disproportionately at risk (and here and here). Their health status is associated with their socioeconomic status – often driven by intergenerational poverty and racism. These groups tend to have high, concomitant levels of nutrient deficiency.
Not ‘seeing’ through medicalised cultures, can exacerbate injustice. Historically, public health directed efforts to helping poorer groups in society. Infectious disease tended to break out in low-socioeconomic neighbourhoods because the nutrition and housing were poor. Today, the additional driver of ‘overnutrition’ from low cost and low value, calorific but nutrient-empty, low-fibre food – accelerates health-harm.
These cascading dilemmas are both a cause and consequence of societies that appear unable to design precautionary policies which ensure immune systems are protected. Not being hungry, and being nourished, are two entirely different concepts.
Throughout COVID-19, not a single policy has been enacted to reduce inequality or increase access to safe and nutritious food. In fact, the opposite is true, e.g. incentives promoting vaccine uptake in communities with already high levels of obesity and other co-morbidities, included offers of free fast-food meals, such as KFC.
These unethical strategies undermine decades of hard work delivering successful nutritional advice and educational interventions. In New Zealand, the life of low-income groups have become more precarious, as wage increases lag behind the cost of living. This has been demonstrated globally.
It’s not that there is a balanced approach. Research and health policy on the social determinants of health and disease have for decades, been dwarfed by investment in medical technologies. Short term incentivisation of economic return is much more compelling to policy-makers than long-term changes, as Skegg pointed out prior to Covid. However, these challenges can be overcome.
The suppression of investment in academia, policy and research results in an advocacy chasm for health (rather than medical) justice. The suppression of investment to explore the social, nutritional, technological and environmental drivers of modern-day disease, means that institutional activities and conflicts of interest as drivers of disease are not challenged.
New Zealand’s academic, policy and research deficit directly produces blinkered policy across the machinery of government, and it has never been more evident than in COVID-19.
It ensures that it is politically, economically and practically impossible to prepare for the next pandemic.
Precarious and inadequate long-term funding to promote local, long-term public good research on interlocking issues of governance, risk, ethics and technology produces a technocratic instrumentalism that can be observed in COVID-19 management and the narrow capture of modelling as a means to justify policy and legislation. It means that scarce few public employees will raise an issue that is likely to promote uncertainty and therefore be controversial.
Denial of a safe space to consider values, ethics, science and technology means that this work won’t be undertaken. So therefore, no scientists were tasked to independently review the published literature and stratify risk from either COVID-19 or the mRNA technology by age or health status. Issues of outcome reporting bias remain unaddressed.
Pharmaceutical treatment recommendations are baked-in, and justified by data supplied by outside jurisdictions.
This sits alongside a policy environment that directs funding to technology and directly away from research – and knowledge - that might critique and steward the much-vaunted technology in the public interest.
This generates more dilemmas. To those outside the medicalised paradigm, these medicalised cultures appear ideological and unjust. To those inside the medicalised paradigm, the political and ethical implications can be over-whelming or ‘unpractical’ and dripping with uncertainty.
Continue Reading: Emergency Powers: [11] The capture of the media & the judiciary here
References are available on the original PDF at TalkingRisk.NZ