The Washington PostDemocracy Dies in Darkness

Let’s explore exactly why Dr. Phil’s coronavirus arguments are so obtuse

Maybe television doctors shouldn’t discuss nuanced issues of life or death on the air.

Fox News interviewed TV personalities Dr. Oz, Dr. Phil and Dr. Drew in the early months of the pandemic, though none of them are infectious disease experts. (Video: The Washington Post)
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At some point, we need to deal with the fact that the honorific “Dr.” is so vague. A guy with a PhD — no small achievement, generally — is a “Dr.” as surely as is a practicing neurosurgeon at the Cleveland Clinic. An epidemiologist who leads a national effort to fight a viral pandemic is a “Dr.”; so is a guy who has a doctorate in psychology. Doctors all around — but with widely varying expertise.

Sometimes the fungibility of the term can make lines of expertise blurry, particularly during cable news appearances.

On Thursday night, Fox News’s Laura Ingraham had two “Drs.” on her program: that national epidemiologist and the one with a psychology degree. The former was Anthony S. Fauci, leading member of the White House coronavirus task force. The latter was Phil McGraw, who is not a practicing psychologist, much less a physician or an infectious disease expert. One of her guests offered Ingraham a nuanced assessment of why the coronavirus that’s spread across the United States demands a unique response and isn’t readily comparable with past outbreaks of other viruses. The other, again, was McGraw.

He started out in reasonable territory.

“Two hundred and fifty people a year die from poverty, and the poverty line is getting such that more and more people are going to fall below that because the economy is crashing around us,” McGraw said. “And they’re doing that because people are dying from the coronavirus. I get that.”

Then came the “but.”

“But, look, the fact of the matter is we have people dying — 45,000 people a year die from automobile accidents,” McGraw said. “480,000 from cigarettes. 360,000 a year from swimming pools, but we don’t shut the country down for that. But yet we’re doing it for this? And the fallout is going to last for years because people’s lives are being destroyed.”

Look, I’m not an epidemiologist either, nor am I a “Dr.” I am, however, someone who can access the website of the Centers for Disease Control and Prevention and someone who understands that you can’t contract “drowning.”

It's mostly irrelevant, but McGraw's numbers on swimming pools are pretty far off the mark. Does he really think that nearly as many people drown in swimming pools as die from smoking? If they did, we would absolutely want to implement stronger protections for swimmers. In reality, though, there are about 4,000 deaths a year from drowning, though it's not clear how many are in pools. His number on deaths from cigarettes is accurate; he overstates the number of deaths in automobile accidents by about a fifth.

As deaths in the United States of covid-19 rise, some have started to question the official death count. But the death toll is most likely undercounted. (Video: The Washington Post)

There are two critical distinctions between those deaths and the tens of thousands of deaths expected this year of covid-19, the disease caused by the coronavirus. The first is contagion. The second is preventive measures.

We've heard the car accident comparison before (including from President Trump) and dismissed it at length. This is the core point, as I articulated last month.

Imagine that most cars used a shared operating system to control internal systems. Suddenly, one day, something goes haywire with the code and the system starts forcing cars to accelerate uncontrollably. We'd suddenly see a lot of deadly accidents and a lot of close calls.
Now imagine if we discovered that the problem could be broadcast over cars’ internal WiFi networks to other vehicles nearby, allowing the problem to jump from one car to the next. We would see places where the problem was worse, like on crowded highways. Very quickly, there would be restrictions about when and where you could drive your car. After all, something in the expected order had changed, and needed to be addressed.

You’d have to imagine something similarly “Twilight-Zone”ish for swimming: perhaps a sentient body of water? That gets into your ears and travels to other bodies of water? Something like that. Call me, Hollywood; we can work something out.

Perhaps more important is the fact that the number of deaths from car accidents and swimming occur in the context of broad preventive measures. There used to be a lot more deaths from car accidents per capita — so we mandated speed limits and seat belts and introduced new safety features and stopped making cars out of the structural equivalent of balsa wood. We fixed the things contributing to the problem. It’s not and can’t be foolproof, but it’s far better because we took action. Same with swimming: We insisted that people put up fences around pools and have lifeguards at the beach. We do things to keep people alive.

In the case of the coronavirus, the number of deaths that are expected is because we’re doing what we can to tamp down the number of deaths. If you think that the 33,000 deaths to date of covid-19 are comparable to the number of deaths in car accidents, understand that the toll would have been far higher without enacting the social distancing measures that McGraw and Ingraham find so onerous. The entire problem with the coronavirus is that it’s new, and we don’t have many tools we can implement to hold it in check. One tool we do have is to limit person-to-person contact, so that’s the tool we deployed. Again, if the weird WiFi-car-contagion scenario above popped into existence, we’d take most cars off the road until we fixed things. It would be a pain and would lead to other problems, but it would be something that had to be done, barring other solutions.

McGraw’s comments came about 24 hours after another television doctor, Mehmet Oz, appeared on Sean Hannity’s Fox News program to similarly discuss reconsideration of coronavirus containment efforts.

“Let’s start with things that are really critical to the nation, where we think we might be able to open without getting into a lot of trouble,” Oz said. “I tell you, schools are a very appetizing opportunity. I just saw a nice piece in the Lancet arguing that the opening of schools may only cost us 2 to 3 percent in terms of total mortality. And, you know, that’s — any life is a life lost, but to get every child back into a school where they’re safely being educated, being fed and making the most out of their lives with a theoretical risk in the backside, it might be a trade-off some folks would consider.”

This was broadly pilloried, and understandably: flippant suggestions that we might push up the death toll of the virus isn’t the sort of thing that people embrace. In fairness to Oz — who is actually a physician, at least — these are the sorts of considerations that doctors and political leaders weigh all the time. Our measures to limit automobile deaths are based on finding a balance between allowing unfettered driving and limiting the number of people who die. We do accept some deaths each year from driving to preserve the ability to drive. Oz’s problem was mostly that he was spitballing on live TV about where that line might be drawn in this case.

In the most generous reading of McGraw’s comments, he was doing the same thing.

Update: In a livestream recorded on Friday morning, McGraw suggested that this was his intended point.

“Last night, I said we as a society have chosen to live with certain controllable deadly risks every day,” he said. “Smoking, auto crashes, swimming. And, yes, I know that those are not contagious, so probably bad examples. ... I referred to them as numbers of deaths that we apparently find acceptable because we do little or nothing about them.”

He suggested listeners abide by the recommendations of their states’ governors.

“One thing we can’t do is just run out the door and say it’s over,” he said.

There is a balance to be found between the negative effects of job losses and isolation and the rate of deaths of covid-19. It’s just that these discussions are best undertaken by people such as Fauci during private meetings at the CDC and not between vitriolic television hosts and people with doctorates in unrelated fields.

What McGraw should do to earn the public’s trust is to focus on the part of his name that indicates his wisdom and infallibility: that his first name is Phillip.