key: cord-0707041-hngopy2o
authors: Cerfolio, Robert J.
title: Policies Should be Based on Data Not Dogma in Medicine and Government
date: 2020-07-03
journal: Ann Thorac Surg
DOI: 10.1016/j.athoracsur.2020.06.009
sha: 51f5c11ac75ae2cd739d40878993881faf4586a1
doc_id: 707041
cord_uid: hngopy2o

nan

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Reply to the Editor:

We appreciate the letter from Mathew and colleagues [1] in response to our article [2] . In general, we agree with most all of their points. We too have utilized periods of apnea as a further iteration and modification of our technique. However, there are a subset of patients that cannot tolerate even 10 to 20 seconds of apnea. While all of these maneuvers theoretically reduce viral shedding, there are no studies that currently measure the amount of shedding viral particles. That leads us to facts over theory.

No doubt the medical facts here are important, yet there is perhaps a bigger message. And this message is simple. Too many policies in both medicine and government are based on dogma and opinion and not facts. This is perhaps no more applicable or hurtful to our society than today given the current political and societal unrest that plagues much of our world. We in medicine are fortunate that our accepted cultural to promulgated laws, rules and principals is evidence based. This is unfortunately not true for many of our federal, state or local policies. It is the ideal time for us as leaders to help drive the change given this pandemic that requires an understanding of science, empathy and the safe care of many.

Physicians are perhaps the most respected members of our society. We are leaders.

Leaders cannot and do not remain silent especially during a crisis.

Therefore, it is incumbent on all of us to help advice our government officials as to when it is safest to re-open our community and where and how. We have shown that even a superspreading procedure like percutaneous tracheostomy is safe for health care workers if they properly wear their protective equipment. Therefore, our citizens should be safe during a commute to work and at work if proper social distances and proper donning of their protective equipment are employed. We are the ones best suited to decide when Covid-19 antibody testing should be leverage and what is the sensible frequency of re-testing patients or healthcare workers with repeated nasal swabs. Currently far too few facts and way too much dogma is used to craft these policies. Leaders challenge dogma and pen policy that bring value to society. As physicians, let's all step up and be leaders today, we have never been more needed nor more suited to do so than now. 

Traditional technique in lieu of novel percutaneous tracheostomy technique during COVDI19

Novel Percutaneous Tracheostomy for Critically Ill Patients with COVID-19