Pharmaceutical Authoritarianism

From the journal Social Science & Medicine comes an interesting paper describing “pharmaceutical messianism” in the context of the COVID-19 pandemic, analyzing the tendencies of politicians and public officials to tout “wonder drugs” and “miracle cures” during major disease outbreaks.

Unsurprisingly, the paper focuses most of its attentions on the much-maligned Ivermectin and Hydroxycholoroquine anti-parasitics, which have shown significant anti-viral properties as well. To their credit, authors Gideon Lasco and Vincen Gregory Yu specifically refrain from commenting on the scientific efficacy of these therapies, confining their analysis to the trajectory of the public attention given these drugs.

Yet what Lasco and Yu overlooked was the degree to which their proposed model for “pharmeceutical messianism” can also describe the trajectory of public attention given the vaccines produced by Pfizer, Moderna, et al, with the dogged insistence of their supreme efficacy against the SARS-CoV-2 virus. Given the amount of political capital invested in the vaccines by politicians and public health officials around the world, we surely should step back and consider what forces might be driving them to advocate so strongly for the inoculations.

What Is “Pharmaceutical Messianism”?

The framing Lasco and Yu give for this notion of “pharmaceutical messianism” is as an outgrowth of “medical populism”, which is at its core the politicization of an health-related crisis.

Following Moffitt (2016) definition of populism as a ‘political style’, Lasco and Curato (2019) introduced the concept of ‘medical populism’ as an analytical tool for health crises. The crux of this concept is “the politicization of a health-related issue” or its portrayal as “a public emergency that demands immediate response,” which medical populists—who are almost always politicians—achieve by: 1) pitting the ‘virtuous’ public against the ‘establishment’ or ‘dangerous others’; 2) dramatizing the crisis through rhetoric and spectacular responses; and 3) simplifying crisis discourse while invoking knowledge claims (pp. 2–3).

Lasco and Yu treat pharmaceutical messianism as an outgrowth of this populist tendency, as politicization of health-related issues can result in public figures promoting specific therapies as a vehicle for attracting wide public support to advance their own political fortunes.

Our framework regards pharmaceutical messianism as a manifestation of medical populism. As recent and ongoing pandemics have illustrated, pharmaceuticals have become more and more incorporated into the performative repertoire of politicians—what Casarões and Magalhães (2021, p. 207), who examined the popularity of hydroxychloroquine in the United States and Brazil during the COVID-19 pandemic, aptly described as “the populist tendency to offer simple solutions to complex problems.” In so doing, these political actors can also craft an imagined antagonism between ordinary, ‘unscientific’ lay people and the ‘academic elite’ of critical health experts. In this sense, the political efficacy of medicines becomes foundational to pharmaceutical messianism.

The Lasco and Yu framework proposes four elements to “pharmaceutical messianism”:

(1) emerges during times of extraordinary health crisis; (2) builds on pre-existing knowledge, practices, and sentiments; (3) borrows from medical, often heterodox, authority; and (4) involves accessible, affordable, and/or familiar substances.

While there is no denying that politicians and public figures have exploited the COVID-19 pandemic for their own political benefit, it would be disingenuous and dishonest to limit criticism of such politicization to the therapies which fall outside the “mainstream”. We should not ignore the extent to which actors such as Anthony Fauci, Rochelle Walensky, and even President Biden have used “the science” behind mainstream healthcare approaches to the COVID-19 pandemic to advance their own political agendas.

Moreover, if we switch from examining advocacy for a particular therapy based on its reliance on “heterodox knowledge, practices, and sentiments” to its reliance on “orthodox” knowledge, strong parallels arise between the cases made for the COVID vaccines and those made for Ivermectin and hydroxycholorquine. What Lasco and Yu term “pharmaceutical messianism” regarding Ivermectin and hydroxychloroquine becomes “pharmaceutical authoritarianism” regarding the Pfizer, Moderna, and Janssen COVID vaccines.

Orthodox vs Heterodox

To understand this parallel, we must understand what is meant by “heterodox” and “orthodox”. These terms actually come into the lexicon from religious and theological discussions, arising from the same Greek root doxa.

The antonyms orthodox and heterodox developed from the same root, Greek doxa, which means "opinion." Heterodox derives from doxa plus heter-, a combining form meaning "other" or "different"; orthodox pairs doxa with orth-, meaning "correct" or "straight."

Thus “heterodox” is defined thus:

contrary to or different from an acknowledged standard, a traditional form, or an established religion

While “orthodox” is defined thus:

conforming to established doctrine especially in religion

Note that neither “heterodox” nor “orthodox” conveys any actual imputation of factual accuracy or even scientific rigor. “Orthodox” is merely that which is accepted by convention, and “heterodox” is that which is not.

If we associate the use of unconventional “heterodox” knowledge with a messianic impulse, with the inherent subversive implications contained with that language, then it is reasonable to associate reliance on strictly conventional “orthodox” knowledge with an authoritarian impulse. The messianic seeks to overturn the established order while the authoritarian seeks to enforce it.

Lasco and Yu’s “pharmaceutical messianism” with regards to Ivermectin and hydroxychloroquine" thus becomes “pharamceutical authoritarianism” with regards to the Pfizer, Moderna, and Janssen COVID vaccines, and we can thus restate their four messianic characteristics as authoritarian characteristics:

• emerges during times of extraordinary health crisis;

• builds on pre-existing knowledge, practices, and sentiments;

• borrows from orthodox medical authority; and

• involves accessible, affordable, and/or familiar substances

COVID Is An Extraordinary Health Crisis

The same environment that gives rise to pharmaceutical messianism also gives rise to its authoritarian counterpart. If COVID is an extraordinary health crisis exploited by advocates of certain therapies, it is an extraordinary health crisis even for “conventional” treatments and therapies.

That COVID has been the dominant news story in the world for the past two years more than qualifies as “extraordinary”, and we need look no further than President Biden’s campaign promise to get the disease “under control” to understand this.

On the campaign trail last year, Joe Biden promised that if elected president, he would get COVID-19 under control.

COVID Vaccines Build On Pharmaceutical Conventions

Neither a messianic nor an authoritarian impulse arises ex nihilo. In describing pharmaceutical messianism, Lasco and Yu take care to highlight that the touted therapies are largely already present.

Pharmaceutical messianism does not exist in a vacuum: It must come from somewhere and/or build upon something. This can be in the form of existing biomedical knowledge, like drugs that are already used for existing diseases, but which are now being forwarded as solutions to the current crisis (e.g. quinine during the Russian and Spanish flu pandemics [Freckelton, 2020]). It can also be in the form of alternative or heterodox knowledge, as in the case of food cures derived from traditional medical (or quasi-medical) ideas and practices (Bitar, 2020). Or, as with the HIV pandemic, pharmaceutical messianism need not even be rooted on pre-existing knowledge; it can flourish just by feeding upon pre-existing public sentiment. Often, a miracle cure taps upon the zeitgeist, whether it be the interminable undercurrent of anti-colonial sentiment, like in Ghana and Cameroon (Cassidy, 2009; Lachenal, 2017), or public desperation for an immediate solution, as in Nigeria (Obadare and Okeke, 2011). What is crucial to this characteristic is that miracle cures do not achieve instant popularity; rather, they: a) usually already exist in some prior form before the pivotal act of alteration and redefinition, and/or b) occur in the ripe environment at the right time in history.

Similarly, political support for COVID vaccines arose from a pre-existing reliance on major pharmaceutical companies to develop treatments for disease, leading to “Operation Warp Speed”, a joint DHHS/DoD effort to expedite the development by the major pharmaceutical companies of said vaccines. Certainly there was a “public desperation” for an immediate solution to the pandemic, given its unprecedented economic and political disruptions worldwide.

COVID Vaccines Borrow The Authority Of The FDA And CDC

The orthodoxy of the Pfizer, Moderna, and Janssen vaccines is established by three words: “Emergency Use Authorization”. The Emergency Use Authorization is the regulatory mechanism by which the FDA permits unapproved medical devices and treatments to be used during a public health emergency—such as was declared last year for COVID-19.

The Emergency Use Authorization (EUA) authority allows FDA to help strengthen the nation’s public health protections against chemical, biological, radiological, and nuclear (CBRN) threats including infectious diseases, by facilitating the availability and use of medical countermeasures (MCMs) needed during public health emergencies.

The FDA, as the government agency charged with regulating the nation’s pharmaceutical industry, is in every regard “the establishment.” By granting EUA for the COVID vaccines, the FDA lent them their imprimatur, conveying the legitimacy and credibility of convention even before the first shot was administered.

This orthodoxy is further reinforced by the position of the CDC that the vaccines are still the “go-to” strategy for dealing with COVID, as stated recently by CDC Director Rochelle Walensky.

“We have made important strides in the year since the COVID-19 vaccination program started. More than 200 million Americans have completed their primary vaccine series, providing protection against COVID-19, preventing millions of cases and hospitalizations, and saving over a million lives. Today’s updated recommendation emphasizes CDC’s commitment to provide real-time scientific information to the American public. I continue to encourage all Americans to get vaccinated and boosted.”

The Narrative Compares COVID Vaccines To Smallpox And Polio Vaccinations

Rightly or wrongly, much of the media defense of the COVID vaccines revolves around comparisons to this country’s past programs of smallpox and polio vaccination.

Given that polio, measles, mumps, rubella, and other vaccines are at the top of the “standard” list of vaccinations administered to children in the US beginning in infancy, establishing an association between the COVID vaccines and these common inoculations leverages the familiarity and public perception of these other shots to provide further credibility and legitimacy for the COVID vaccines.

Thus we can see that the messianic impulse described by Lasco and Yu is paralleled by an authoritarian one. “Messianic” claims for therapies such as Ivermectin and hydroxychloroquine sit alongside “authoritarian” claims for the COVID vaccines. There are claims which attack medical convention and claims which enforce medical convention.

Messianic vs Authoritarian: What Is The Difference?

The natural question arising at this juncture is “so what?”

Does the authoritarian backdrop for COVID vaccine advocacy alter the vaccines’ scientific efficacies? No. No more than the messianic backdrop alters the scientific efficacies for Ivermectin and hydroxychloroquine. The Pfizer and Moderna preparations do what they do regardless of how we regard them politically, and the same can be said for Ivermectin and hydroxychloroquine. The risks and rewards of each are what they are regardless of the surrounding political advocacies.

However, appreciating the context in which advocacy for either orthodox treatment (COVID vaccine) or heterodox treatment (Ivermectin) occurs is an important dimension for assessing the degree to which various biases and prejudices come into play on both sides—and it is certain that bias and prejudice are rampant for both orthodox and heterodox treatments.

While Stella Immanuel’s impassioned speech that hydroxychloroquine is a “cure” for COVID was unquestionably an exaggeration of the drug’s benefits, there is no denying the body of clinical evidence, including Randomized Controlled Trials, indicating that it is effective in treating the disease. Didier Raoult’s claims of hydroxychloroquine efficacy might be now largely discredited, but that does not alter the remainder of that body of evidence.

While the FDA bizarrely chose to refer to Ivermectin as a “horse medicine”, there is no denying the body of clinical evidence, including Randomized Controlled Trials, indicating that it is effective in treating the disease.

While the COVID vaccines were initially touted as the way to “crush” the virus, their impact has been considerably less than that.

Advocacy Is Not Evidence

The messianic vs authoritarian framework highlights an imperative when assessing anything involving human health and medicine: advocacy is not evidence. Anthony Fauci saying COVID vaccines work does not make it so. Didier Raoult saying hydroxychloroquine works does not make it so. Rochelle Walensky saying that the COVID vaccines are safe does not make it so.

Advocacy is, ultimately, merely opinion. Orothodoxy is, ultimately, merely opinion. Heterodoxy is, ultimately, merely opinion. The merits of any opinion are measured by the reasoning behind the opinion, and in both science and medicine those merits are measured strictly by the facts and the data.

Lasco and Yu presented their framework as a cautionary against the “messianic” claims for unorthodox COVID treatments. Their cautionary applies just as much to the “authoritarian” claims for the orthodox COVID vaccines.