Voting matters. Ever since medical school, I have become more and more certain that the most effective, most overlooked, and most cost-conscious way to improve the health of populations is through changing the socioeconomic milieu. I believe this matters more than costly subspecialist care (including the medicine I practice) and even more than primary care (for which I have immense respect). We can make the biggest impact on long-term health through bigger-picture interventions: addressing the economy, jobs, poverty, housing, food-insecurity; education and literacy; crime, violence, discrimination, racism, incarceration; access to health care and mental health services; even thinking of the environment. Although many of the diseases we struggle with today result directly from obesity, hypertension, diabetes, and other common conditions, I was encouraged in medical school to think even bigger than that: they result from the way our communities are structured, the unequal distribution of wealth in this country, and the ways our government does and does not support us.

Over time, I have become convinced that voting is not only essential to giving us a voice in matters directly related to health care, but also to shaping a wide range of issues that indirectly affect the health of our communities. There are few issues that will not impact your health or the health of your children or grandchildren. 

Which is to say that I am echoing the many messages that have been circulating recently: vote. Take charge of your health. When I rotated through family medicine as a student, I wrote "prescriptions" for a healthy diet or exercise regimen. These days, with my practice, I don't write many prescriptions anymore. But today's Rx is Vote. Make your voice heard.

"And we are here as on a darkling plain
Swept with confused alarms of struggle and flight,
Where ignorant armies clash by night."
-Matthew Arnold, "Dover Beach"

I didn't quite get the chance to blog on President Trump's COVID diagnosis, but I did have several thoughts about it. Most importantly, I try (though it may be impossibly difficult) to divorce my political opinions from the medical nature of an elderly man getting COVID. Although President Trump's policies have made this pandemic what it is and his personal beliefs and behaviors contributed to his infection, his becoming ill is not cause to push political views. Each COVID infection is a terrible tragedy.

But I did have several random thoughts about this situation. How do we think about health privacy? Anyone who remotely deals with medical data knows a host of privacy laws protect our individual health information. Does this apply to the president? What rights does the public have to know about the health condition of the president of our country? What about Congress or the principal officers of the executive department?

Coronavirus and its treatment (particularly the steroid dexamethasone) may affect someone's mental capacity, executive function, and decision making. Should the medical team actively assess that? Should the President of the United States with his attendant powers and responsibilities be held to a specific standard of capacity? When do we start talking about the twenty-fifth amendment?

The President's infection with COVID also illustrates the stark realities of socioeconomic disparity. At the start of the pandemic over half a year ago, I read a lot that the virus does not care if you are rich or poor. This is both true and not true. Like the vast majority of diseases, illness can strike the wealthy, but it tends to do so less often than it strikes the poor. Money can provide significant protection. I remember at the height of the first wave, wealthy New Yorkers fled to second homes. Even now, the majority of those who can work at home are richer than those who have to physically go to work. 

Clearly, President Trump's infection can be traced to poor distancing, mask-wearing, and preventive measures. But after he acquired the disease, we see the second big socioeconomic disparity. He received treatments that are in short supply. I don't have access to antibody cocktails, and my county has a limited supply of remdesivir antiviral. I strongly believe that care shouldn't depend on who you are, in either direction. I've taken care of death-row inmates and millionaire CEOs and personal acquaintances, and though I'm sure that has a subconscious effect, I actively try to provide the same care. Unfortunately, the reality is that wealth and status make a difference.

There are many other ways to look at this outbreak happening at the top of our government, but these are just my initial takes. We ought to recognize that perhaps the most important and influential person in the world acquired this disease, and he had the opportunity to change the course of the pandemic many months ago. But I also think we must acknowledge that his infection is one among millions. Tomorrow I will still go to work and do what I can for the tragic victims of this pandemic.