AAPS: A crank medical “association” promotes COVID-19 disinformation

I’ve been writing about the Association of American Physicians and Surgeons (AAPS) since I first discovered this far right wing/libertarian crank organization disguised as a legitimate medical society and its crank journal, the Journal of American Physicians and Surgeons (JPANDS) in 2006. At the time, I noted that the group was pretty much a fusion of a John Birch Society-like right wing group with a medical society and that it trafficked in the most vile antivaccine misinformation (e.g., that shaken baby syndrome is a “misdiagnosis” for vaccine injury and Andrew Wakefield’s recent claim that the measles vaccine will result in a mass extinction of humans), anti-immigrant fear-mongering, climate science denial, blaming breast cancer on abortion using execrable “science,” and more. The AAPS views doctors as some sort of mythical brave mavericks outside the herd whose godlike total autonomy must never be infringed by the government or anything else and rejects even the concept of a scientific consensus about anything. (Donald Trump’s first Secretary of Health and Human Services, Tom Price, is a member of AAPS.) Earlier this year, it’s even sued to protect its “right” to promote antivaccine misinformation. So naturally, six months plus into the COVID-19 pandemic, I wondered with AAPS was up to with respect to medical and political issues surrounding coronavirus. I was not surprised to learn that it’s as cranky and pseudoscientific as ever from their email newsletter. (Yes, I’m on a fair number of crank mailing lists. I do it for blog material.)

First up, from Monday, we have Dr. Jane Orient, the executive director of AAPS, whom we’ve met before, such as when during the 2016 election cycle she promoted the myth at the time that Hillary Clinton had Parkinson’s disease and peddled antivaccine conspiracy theories around Zika virus). She’s also on record as denying the very concept of a scientific consensus about anything. Unsurprisingly, her email claims that masks don’t work to slow the spread of COVID-19 (because, being a right wing organization, of course AAPS doesn’t accept that masks work):

We’re supposed to follow “evidence-based medicine” these days, but there is no firm evidence to support the masking and “social distancing” mandates being imposed throughout the land. CDC chief Robert Redfield asserts his opinion that the U.S. could get the coronavirus under control in 4 to 6 weeks if everyone wore a mask. He relies largely on a study of masking health care workers and patients in a Massachusetts health system.

Dr. Redfield is a political hack, which is a large part of the reason why the CDC has performed so poorly in response to the COVID-19 pandemic. He’s in over his head. I always thought his statement about masks from last week published in JAMA was irresponsible hyperbole. The editorial, actually, isn’t as overblown as it was portrayed in the news, as it actually makes no claim that universal masking would get the pandemic under control in 4-8 weeks. Apparently, he did say it in this discussion on YouTube, though, with Dr. Howard Bachner, the Editor-in-Chief of JAMA. As for the study, it was a nice observational study that showed that universal masking at Massachusetts General Hospital was associated with significantly lower rates of positivity for SARS-CoV-2 (the virus that causes COVID-19). The study has some weaknesses and potential confounders, but overall it’s pretty strong evidence for the efficacy of masking in healthcare settings. Yes, it might not apply outside of healthcare settings, but, as I said, Redfield is a hack. Even so, the MGH study was not the only study that his JAMA editorial relied on.

In actuality, the evidence that masks have a significant effect in preventing the spread of COVID-19 has been accumulating for quite some time, although that hasn’t stopped cranks from promoting disinformation about masks.

Cue Dr. Orient:

We have had some large experiments underway. In the U.S. we have recently had thousands of protesters crowded together, chanting and shouting. We also have large homeless camps. No masks, no distancing, no handwashing, and no constant sanitizing of anything a human might have touched. Are the surges of positive tests coming from there?

Yes, in the several weeks since the Black Lives Matter protests erupted, it’s become clear that, contrary to the fears expressed by some, the protests appear not to have led to a surge in COVID-19 cases. Paradoxically, they might actually have slowed the spread of COVID-19 in cities with large demonstrations. I’ll be honest, though. The “study” referenced to support this possibility was published as a white paper by the National Bureau of Economic Research by economists with no expertise in epidemiology or infectious disease. So I take it with a huge grain of salt. Basically the findings led the authors to speculate that the large protests increased stay-at-home behaviors among non-protesters, thus slowing the spread of coronavirus. Whatever one thinks of this particular study, though, it’s quite clear that, contrary to the fears hyped by those opposed to BLM and even some of us who support it, the mass protests appear not to have led to detectable increases in COVID-19 transmission attributable to the protests. Of course, the reason is probably that the vast majority of those protesters were also very good about wearing masks and, when possible, observing social distancing, and that these protests were outdoor protests.

None of that stops Dr. Orient from JAQing off:

Does the absence of reports mean that it’s safe to protest, at least for the correct cause, or to live on the streets? Maybe so, if you’re outdoors. (Then why should anyone wear a mask outdoors?) Maybe we just don’t know because contact tracers don’t ask.

Had persons who are testing positive been in Mexico, where cases are surging? (In Chula Vista, Calif., the majority of COVID-positive emergency-room patients had been in Mexico.) Were the “cases” confined to a nursing home, unable to go anywhere or even to have visitors? Were they alone except when breathing the air in a supermarket where an unmasked person might have been? We don’t know.

JAQing off, for those not familiar with skeptical lingo, refers to “just asking questions.” It’s a tried-and-untrue crank technique designed to make wild assertions and speculations seem palatable by making them in the form of questions rather than statements. The idea is to ask leading questions in order to influence the views of those listening to be receptive to the misinformation being implied.

In this case, Dr. Orient’s JAQing off plays on the racist anti-immigrant conspiracy theories beloved of AAPS that foreigners are bringing disease into this country, in this case COVID-19. Of course, one can’t help but add a sarcastic rejoinder: Given that the US only has 4% of the world’s population but has still managed to amass 25% of the world’s cases of COVID-19 and 25% of the world’s deaths from coronavirus, in reality shouldn’t it be other countries who fear Americans bringing disease and death to their countries? In fact, that’s already happened. The EU won’t let Americans in.Indeed, most of Europe and most of Asia are currently off-limits to American travelers, and the list of international destinations that still welcome Americans is now quite small.

The story referenced is also not exactly as presented. It’s a story from early June of how Americans living in Mexico were crossing back to the US to seek medical treatment. There is, of course, evidence that travelers from other countries did spark COVID-19 outbreaks in the US very early on in the pandemic, for instance from China in January and February before the travel ban. However, since at least February, it’s been community spread of the virus that’s fueled the rise in COVID-19 cases and deaths.

Next up, Dr. Orient pulls the Sweden gambit:

There is international experience, notably in Sweden. Children went to school, mask-free, behaving like normal children. There were no lockdowns, and the economy did not crash. There were fewer deaths on a per-capita basis than in locked-down, economically devastated New York (see figure below). As observed on Twitter, if New York had been a drug and Sweden a placebo, the trial would have been stopped in April for ethical reasons.

Included in the email was this chart:

Comparing Sweden to New York State, for instance, rather than surrounding countries, is an intentionally deceptive way of framing the issue. Per million people, Sweden has suffered 12 times more deaths than Norway, seven times more than Finland and six times more than Denmark, for instance. It also turns out that Sweden has not been doing that well. and didn’t avoid economic pain after all:

Sweden’s central bank expects its economy to contract by 4.5 percent this year, a revision from a previously expected gain of 1.3 percent. The unemployment rate jumped to 9 percent in May from 7.1 percent in March. “The overall damage to the economy means the recovery will be protracted, with unemployment remaining elevated,” Oxford Economics concluded in a recent research note.

This is more or less how damage caused by the pandemic has played out in Denmark, where the central bank expects that the economy will shrink 4.1 percent this year, and where joblessness has edged up to 5.6 percent in May from 4.1 percent in March.

In short, Sweden suffered a vastly higher death rate while failing to collect on the expected economic gains.

In addition, the majority of cases and deaths in New York State were in New York City, which has as of today 227K confirmed cases and nearly 23,000 deaths, while New York State has 413K confirmed cases and 32,000 deaths. What’s different about NYC compared to Sweden? It’s a very densely packed metropolis. Finally, NYC and NYS are actually doing pretty well right now, with zero deaths from COVID-19 reported in NYC on Monday, only two in NYS.

Next up, Dr. Orient returns to masks:

You can spend $70 on a fashion mask. It is probably not FDA-certified, but an FDA certificate may be meaningless. After 4 hours of wear, you should wash a cloth mask and dry it in the sun.

For a summary of the evidence, see Mask Facts, the Doctors for Disaster Preparedness Newsletter, January 2020, and an extensive review by the Center for Infectious Disease Research and Policy (CIPRAP).

The first bit is obviously an appeal to ridicule, a logical fallacy. So what if you can buy a fashion face mask? One would think that, über-libertarian capitalist organization that AAPS is, rejecting, as it does, any hint of government regulation of physicians or government funding of health care, Dr. Orient would approve of entrepreneurs seeing a business opportunity and seizing on it to make a decent profit. As for the “extensive review,” I can’t help but note that it was published on April 1, nearly four months ago. Science changes, and evidence has been accumulating since then supporting the efficacy of face masks has been accumulating steadily.

One also notes that the Doctors for Disaster Preparedness is an AAPS-adjacent crank organization that shares its antiscience views, including anti-environmental forms of denialism (including DDT ban myths, ozone depletion denial, global warming denial, and crank theories about radiation hormesis) and medical denialism (vaccine denial and HIV denial). Unsurprisingly, its masking article includes some JAQing off parroting the anti-BLM and anti-immigrant sentiments that Dr. Orient did:

Contact tracers are to be deployed by hundreds of thousands to interview persons who test positive, to find and isolate persons who might have been near them. It would instead seem logical to ask sick people where they might have been exposed, as when investigating an outbreak of food poisoning. Asking about attending a Black Lives Matter protest is off-limits, at least in New York. And what about border crossing?

It just happens that surges in border states have occurred in border counties, coinciding with a COVID surge in Mexico. The three Rio Grande Valley counties—Starr, Hidalgo, and Cameron—had a 29% hospitalization-to-case ratio in early July, when the rate for the U.S. was 5.8%. This suggests that seriously sick patients may be crossing the border in search of treatment (tinyurl.com/y88cvxz3).The number of illegal immigrants crossing the southern border surged 40% in June (tinyurl.com/yaj6dt3x).

I refer to my previous rejoinder. The rest is a combination of cherry-picked studies, incidents, and disinformation, false comparisons, and even lies about how masks supposedly cause harm through being a “breeding ground for bacteria and fungi” and the accumulation of virus. (They don’t, and medical contraindications to wearing a mask are rare.) There’s also a bit of “whataboutism”:

While COVID-19 “case” counts dominate the news, where is the coverage on public and private debt, loss of tax revenue, rampant fraud in aid programs, corruption and malfeasance in the FBI and other government agencies, and other urgent issues?

Could it be because coronavirus pandemic remains the worst single health crisis in a century and there’s no sign of its ending any time soon? Just a thought.

As for “Mask Facts,” it’s a mixture of deceptively framed information, cherry picked science, and spin that might well be worth its own post, given how long this post has grown.

Yes, AAPS is doing what AAPS always does, promoting science denialist misinformation and disinformation. I’m only surprised it took me so long to get around to looking at the misinformation it’s promoting.