The other sure thing

We’ve touched on death in these pages before. I don’t know that we’ve ever talked about taxes.

I heard a politician talking about tax cuts. That seems to be the central theme of nearly every Republican. We’ve been taught to think of taxes as a bad thing and as cutting them to be the best thing our politicians can do for us.

If cutting them is the best thing they can do, why do they have jobs? Taxes pay their salaries. If we don’t need taxes and don’t need the services provided by them, why do we need legislators? It would seem their first course of action should then be to eliminate their own jobs.

But what are taxes but our shared vision as to how to build a society? We may not all agree on every expenditure – I’d be frightened if we did – but most of us like to have roads to travel on. Those of us who live where it snows like to have the snow removed now and then. Having trash removed comes in handy. Water we can drink? Not a bad idea. Sewage that flows out of pipes away from our houses? Hey, I could use that. Treating that sewage instead of just having pipes that run into the nearest body of water? Another pretty good idea.

It seems those who clamor for tax cuts are not the same who call for defunding the police. Something ironic there. Cutting taxes means defunding something, and taken to the extreme I’ve seen proposed means defunding nearly everything (including schools, Social Security, Medicare, nearly all social services).

But what does “defunding”mean? And what do the police do? (And I don’t mean to say that former Chicago Mayor Richard J. Dailey was correct that “The policeman isn’t there to create disorder; the policeman is there to preserve disorder.”1) If our interest is public safety, are police departments the best place for all of those dollars? The police likely would be the first to tell you that their job is to respond to crime after it happens. They arrest the alleged perpetrators and work with the DA to develop a case. Their crime prevention role seems to be primarily to convince us that the likelihood of being caught and the repercussions of being convicted outweigh the benefits of committing a crime. (That, and going to elementary schools to scare kids out of smoking weed; though I don’t think that program is still in existence.)

My city alder just wrote a thoughtful post about public safety which included this:

For once, I would love for our city to have intentional city-wide conversations on what public safety should mean.  I had often wondered if we could ask the question, what would you need to feel safe in the City of Madison -without framing these conversations around police and fire-what people might answer?  This question faces challenges because of competing forces preventing change.  As an elected official, if you explore alternatives to policing, you can be labelled as soft on crime by the police union and others, making electability more difficult.  For most of us, we have grown up with a media landscape or narrative about policing that informs us.  Think of the hundreds of cops shows on TV and at the movies.  For me, I cannot escape the fact that the horrific racial disparities within our local criminal justice system and policing could not exist without the other. 

    With calls to defund or abolish the police, I am left curious that if I woke up tomorrow, and there were no police at all, who would investigate murders, who would respond to sex trafficking, who is going to be the first responder if there is a shooting?  I could foresee a future where we might take long held police duties like traffic enforcement and civilianize these roles.  Imagine if you were speeding and you were pulled over by someone without a gun ( let’s call them  a Civilian Traffic Buddy), knowing that the worse outcome would be a citation (unless you were in the act of a felony) rather than jail or death.”  

My own two cents on that last part. 1) In Great Britain, between 4 and 5% of police officers are armed. Police firearms were “intentionally discharged at persons” four times in the year ended 3/31/2022. 2 This number is reported as stable over the past several years.

In contrast, in the US, police have shot and killed an average of 982 people per year over the past six years.3 As a percentage of total population, police kill Black people at a rate 2.5 times greater than that at which they kill White people, and kill Latin@ people at a rate nearly double that of White people.

My other penny’s worth…2) Alder B above talks about “the worse outcome” of a traffic stop being a citation “(unless you were in the act of a felony)”. That one deserves a closer look. When I worked in a trauma unit, the majority of the people I saw were there for injuries related to alcohol. A 90 day retrospective study of patients at another trauma center found that ⅔ of drivers tested positive for alcohol or other drugs.4 When the trauma unit was slow I used to joke about rounding up more business by heading out to the bars, buying a round for the house, and making sure everyone had their keys. The flip side of that (being serious) is that this represents an opportunity for a cultural change that can actually help prevent crime and injury, in other words be a public health measure. In the state of Wisconsin, first offense drunk driving results only in a citation – a traffic ticket. Driving drunk only rises to the level of a felony on one’s fourth conviction.5 Of course, it also becomes a felony if you kill someone. What if our culture didn’t glorify drunkenness? (Those of us who are old enough recall when we glorified cigarette smoking and televised athletic events were sponsored by tobacco companies, not just breweries. Culture change is possible.) What if bartenders and friends were encouraged and trained to take away someone’s keys when they were drunk? What if all cars had ignition interlocks to prevent starting by someone who is drunk? The average cost is $50-$150.6 Might that cost come down if the devices were produced in greater numbers?

Alder Benford went on to talk about a new city program. If you watch TV drama, this has already been implemented on “Station 19”.

 “By now, most of you have heard of our awesome CARES  team- Community Alternative Response Emergency Services (https://www.cityofmadison.com/fire/emergency-medical-services/community-alternative-response-emergency-services-cares).  As a social worker, I was so excited to learn before I joined the council, that we were on the path to developing a model, like other cities.  A public safety service that could send a skilled paramedic and mental health professional on a 911 call that does not require the police.  As I dream about reimaging public safety, so that all, regardless of our backgrounds, feel safe, I reason that CARES is our first major step as a city to accomplish this goal.  Alders agreed  to fund a tactical expansion of CARES to ensure additional coverage and long-term success.  I am excited about the future of CARES.

This is another way that tax dollars can go toward public safety and violence prevention. Not all calls to 9-1-1 require a police response. Police response to mental health crisis often results in unnecessary death. To put it more bluntly, it results in the police killing the person they were called to help.7

So when people talk of “defunding the police”, the true meaning is often redirecting limited funds to programs more likely to contribute to public health and violence reduction than the current system. It is not an attack on police. It is not anti-authoritarian. It is pro-public safety.

How we make funding decisions comes down to how we set our priorities. If our priority is to catch people after they have done wrong, increasing police funding may well be the answer. If our priority is to change the conditions which lead to crime, transferring some of those funds to other programs which address social inequities may be a more prudent use of dollars.

So while it is possible that “’tis impossible to be sure of any thing but Death and Taxes7, how we levy and how we use those taxes is one of the most important discussions we can have.

1 https://www.chicagomag.com/city-life/January-2020/The-Chicago-Political-Quote-Hall-of-Fame/

2 https://www.gov.uk/government/statistics/police-use-of-firearms-statistics-england-and-wales-april-2021-to-march-2022/police-use-of-firearms-statistics-england-and-wales-april-2021-to-march-2022

3 https://www.statista.com/statistics/585152/people-shot-to-death-by-us-police-by-race/

4 •Walsh, J. M., Flegel, R., Atkins, R., Cangianelli, L. A., Cooper, C., Welsh, C., & Kerns, T. J. (2005). Drug and alcohol use among drivers admitted to a Level-1 trauma center. Accident Analysis & Prevention, 37(5), 894-901. doi:10.1016/j.aap.2005.04.013

5 https://wisconsindot.gov/documents/safety/education/drunk-drv/owi-penchrt.pdf

6 https://www.wisconsin-owi.com/blog/2021/01/07/how-much-does-it-cost-208191

7 https://www.washingtonpost.com/investigations/interactive/2022/police-shootings-mental-health-calls/

8https://ia902807.us.archive.org/0/items/coblerofprestonf00bull/coblerofprestonf00bull.pdf

Note: I attempted to reach my alder for permission to quote from his weekly newsletter. I have not received a response but, as this was a newsletter sent to all constituents, privacy did not seem to be an issue. Since I didn’t get his consent, I ask for forgiveness.

COVID ICU

It’s time for my next round on a COVID-19 floor. This time it’s the ICU. I have been on General and Intermediate Care on my previous tours. ICU is for the sickest of the sick. My patients are on ECMO (Extra-Corporeal Membrane Oxygenation). This isn’t merely a ventilator that assists you to breathe or breathes for you. This is an artificial lung. Your blood leaves your body via a ½ inch or so diameter line, runs through a machine to remove CO2 and add O2, then sends it back into your body via another line. (That’s what “extra-corporeal” means – outside the body.) One line comes out of your neck and the other your groin. Mobilization is a bit tricky. You don’t want any leaks.

Ready for action as soon as you add gown and gloves. The conehead look isn’t the most comfy, but it’s cheaper than the 3M PAPR (Powered Air-Purifying Respirator). There is no patient information on the wall behind me.

Some of these folks have been in this hospital for two months. They came from smaller hospitals that didn’t have the means to provide the treatment they need, after exhausting all options available to them. At least one has been sick since August – 3 months and counting. They are young and unvaccinated. Will they survive? Beats me. Are they anti-vaxxers? Beats me. My job is to help them, not to second-guess them.

(But since you ask, let’s just say that, if I were a betting man, my money would be on “yes” to surviving. As to whether they are anti-vaxxers or just think they are immortal, that one’s a tossup. This batch of patients are young enough to be my children and have survived two months in the ICU.)

A friend and spouse are vaccinated. One of their two adult children is vaccinated. The other is not, along with spouse and kids. We’ll call my friend Vac and the child Not. Vac was at Not’s house and Not confessed (after several hours together) to feeling ill. Vac had a home COVID test handy – Not was positive, confirmed by another test the next day in a health care facility. Not’s spouse and children are all sick. Vac remains well and has tested negative twice since that exposure. Vac’s spouse and other child are also fine. Do you think maybe the vaccine works?

One of the anti-vaccine arguments is based on “natural immunity”. People want their own immune systems to fight it out with the novel coronavirus. Note that name: novel. Our immune systems work by developing antibodies against invaders. If an invader is known, we have the means to develop a specific defense rapidly. If the invader is unknown (novel), we toss stuff at it while we try to figure out what to do. If the virus is strong enough, we may die first. (Or, in the case of the polio virus, just some motor neurons die. If enough die, we die. If we’re lucky, we’re paralyzed.)

What does a vaccine do? It enables our body to recognize the invader and develop specific antibodies. If we then come in contact with the disease, our immune system is up to the task. The vaccine enables our natural defenses to work.

Did you go to public school? You probably had a bunch of vaccines before you were allowed to attend. We don’t want you to come into close quarters with others and infect them with measles, mumps, rubella, diphtheria, pertussis, poliomyelitis, etc. It’s what we call Public Health. That’s why you should get the COVID-19 vaccine. On one level, I don’t care whether you get the disease. You are “free” to get sick and die if you so choose. Should you also be free to infect others or use scarce resources by running to the hospital when you get sick? Should you be free to demand that said hospital treat you with horse dewormer or a “cleaning” with an injection of a disinfectant like bleach?

Don’t tell me you “did your own research“, like a certain professional football player. Those of us who use research in our lives know that research involves experimentally testing a hypothesis. Before you do your research, you do a literature review, to see what has already been done. Is that what you did? A lit review? Did you actually read the literature, or just listen to a talk radio host talking about the literature? When you do a critical review of the literature, you appraise it against a set of criteria. There are what we call “levels of evidence”. Some evidence is better than others. No study is worth a lot before it has been replicated by someone else. Did you believe one person who runs counter to the mainstream because they say they are a doctor?

If you’re against vaccines (or at least this one) because they’re “unnatural”, are you against soap and water or antibiotic ointment if you get a cut? Why not just let your body’s natural defenses go to work? Maybe you’ll live, maybe you’ll die. Maybe that cut finger will result in being faced with the choice of death or amputating the arm. Amputation is unnatural. Death is completely natural. Decision made.

After all, life is 100% fatal. Why wait?

[Editor’s note: Sorry, it has been a rough week at the hospital. The writer apologizes to those who do take care of themselves and others and is not wishing an early and painful death on anyone. He is tired of reading about people refusing help until it is too late and then demanding their own particular choice of help. He is tired of reading about people looking for lawyers to sue hospitals for employing the standard of care instead of listening to their half-baked theories. He is tired of reading about people who refuse to take action to protect themselves and others, then beg for your prayers and money for funerals and to raise the children of stupid people who refuse the vaccine, refuse to wear masks, and think they are standing up for freedom. He is sick and tired in general this week – and he hasn’t even finished the first week of this rotation.]