We fear things in proportion to our ignorance of them.

by U.S. Medicine

December 7, 2014
Editor-In-Chief, Chester "Trip" Buckenmaier III, MD,  COL, MC, USA

Chester “Trip” Buckenmaier III, MD, COL, MC, USA

We fear things in proportion to our ignorance of them.
Christian Nestell Bovee (1820-1904)

I had the honor of being invited recently to speak at the 39th annual Garland Lecture series at the Boston Medical Library. As I tend to do in order to combat the chaos of modern air travel, I arrived hours early for my flight to Boston. With time on my hands and no breakfast in my stomach, I decided to stop in for a coffee and bagel at an airport bar to wait for my flight. I was, as they say, minding my own business, watching CNN on the television above the bar.

The story concerning the Maine nurse Kaci Hickox, who had recently returned from Sierra Leone, West Africa, where she had volunteered to help with the Ebola epidemic, was one of the new items that day. She has received national attention because of her crude handling and involuntary three-day isolated quarantine when she returned to the U.S. through New Jersey, and her refusal to remain in isolation as she had been asymptomatic. Her desire not to be quarantined is consistent with current Centers for Disease Control and Prevention (CDC) guidelines, which reject state-mandated quarantine for health officials returning from Ebola-stricken areas of Africa. Since her return, Ms. Hickox has maintained that her quarantine was unnecessary based on the current scientific understanding of the virus and its transmission (by direct contact with contaminated body fluids, not through airborne transmission like the flu). Furthermore, the CDC has expressed concern that unwarranted quarantine of health professionals returning from fighting the disease and its spread will become a significant deterrent for other altruistic health professionals from volunteering to travel to West Africa to help in the future. Despite these facts, Ms. Hickox has received significant public ridicule from a fearful and ill-informed public that has been fueled by the news media focused more on the entertainment value of Ebola fear than the medical facts surrounding this public health issue.

From my perspective, based on the best science available, we should be celebrating Ms. Hickox’s efforts and those health professionals like her, not sequestering her behind plastic and subjecting her to public loathing born of uneducated fear.

These were my thoughts as I watched the CNN report that was spiced up with frightening graphics better suited for a violent video game than a supposedly informative national news broadcast. My waitress was watching the same newscast with a look of concern on her face and commented that she was not sure she was comfortable with a nurse who might be harboring Ebola walking around in Maine. Perhaps I should have focused on my bagel and let the comment pass, but the physician in me cannot resist the opportunity to educate the public on health related issues. In my best “doctor voice,” I briefly described why Ms. Hickox’ handling was excessive, how unlikely it would be for her to spread the Ebola virus while asymptomatic and how we should appreciate healthcare workers willing to confront this epidemic in Africa as opposed to waiting for it to appear on our own shores. 

The waitress seemed interested in my view but had no time to reply, as she had more customers to serve. An older gentleman at the end of the bar remarked (rather loudly) that people dumb enough to travel to areas with Ebola should be locked up for the 21-day incubation period. A smarter physician would have paid for the man’s food and calmly disengaged at this point, but the “misinformation” gauntlet had been thrown down and I could not resist the challenge to inform another misguided member of the public. I calmly outlined my reasons for my statement and explained how they were backed by the best evidence available for Ebola by the CDC. I also mentioned the important service these healthcare providers were giving this country by confronting the disease head-on in Africa. 

His response to my patient and (I thought) eloquent presentation of the Ebola facts was, “Well, you’re just an idiot!” I mentioned at that point that I was a military physician and knew something of what I was discussing. He responded by storming out of the bar. The poor waitress looked at me kindly and apologized for bringing the issue up in the first place.

Not the outcome I expected but perhaps another indicator of the media-induced fear Ebola has engendered in the American public. Certainly my desire was neither to raise this gentleman’s ire nor provoke this confrontation, no matter how inconsequential it was. The encounter bothered me during my flight and throughout the evening lecture and dinner. The present situation concerning Ebola in this country echoes the hysteria and cruel public backlash against the HIV epidemic in the 1980s. I would suggest that fear is a natural human response to situations that we do not understand. In a more-perfect world, the news establishments would be more interested in providing the public with useful information on Ebola as opposed to capitalizing on the drama and fear engendered by this deadly disease. Sadly, the fact is that human suffering sells advertising space on the television. 

Granted, my own attempt to educate the public failed comically and spectacularly at the airport, and perhaps the gentleman labeling me as an idiot was more prophetic than slanderous. However, I believe that we in federal medicine have a responsibility to strive to inform our patients and the public about the facts of Ebola. I think public service informational announcements on what Ebola is and is not are needed to counter the drama surrounding this disease as presented by the news media. I often like to tell resident physicians that there are few medical conditions for which there are no treatments, with the exception of stupidity, which often proves fatal. There is a serious ignorance and lack of understanding within this country concerning Ebola, and as federal medicine providers we would be idiots not to try and impact on that educational deficit.


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