Presidential lessons about the use and misuse of sarcasm in medicine

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April 29, 2020 -- We made it to hump-day, CurveFlatteners. This morning you’ve got Mitch Shannon at the keyboard.

A few days ago, U.S. President Donald J. Trump inferred household bleach might be ingested as a remedy for Covid-19, reconsidered his statement a day later, and then claimed he had been offering “sarcasm.” If 360-degree head-spinning could be developed as an antiviral treatment, the president might be onto something. It can’t, and he isn’t.

President Trump did, however, provide a useful service in drawing attention to the under-researched role of sarcasm in clinical medical research, a field pioneered in the mid-19^th century by Herr Professor-Doktor Siggi “Shecky” Haufleiden of Vienna’s famed Institute of Medical Sarcasm. The seminal work of Haufleiden and colleagues established sarcasm as a cornerstone of medical practice, and created a canon of work such as:

• Step off the scale, please. I see we’re not neglecting our cheesecake intake, are we, Frau Burkhalter?
• No, your condition probably isn’t going to kill you. But my receptionist’s boyfriend will if you keep bothering her.
• Of course, it’s entirely your decision whether you keep smoking. I’m certain that either way, you’re bound to enjoy the full support of your undertaker.

Sarcasm, when used appropriately, is recognized as a valuable tool in the practitioner’s armamentarium. However, when applied injudiciously or without consideration of potential outcomes (as was certainly the case in the president’s bleach recommendation), the result may be sub-optimal. It is good to recall a familiar saying among security personnel named Spike, Chief, and Mongo in a popular tavern in the Old First Ward of Buffalo, N.Y.: “Sarcasm is what gets you thrown down a flight of stairs on Saturday night, my sarcastic friend.” So clearly stated. So true.

COVID CHRONICLE 04-29-20

• Transmission rates for Covid-19 have been cut in half, but the fatality rate has more than doubled in Canada, according to information released yesterday (04/28.) Calling the data a "paradox," chief public health officer Dr. Theresa Tam said the anticipated fatality rate has now been adjusted up to 5.5 per cent, from the 2.2 per cent estimated April 9. In reports in the Globe and Mail newspaper [article is behind a paywall] she says: “Outbreaks in long-term care and seniors’ homes are driving epidemic growth in Quebec, Ontario and Nova Scotia and are responsible for the majority of all deaths in Canada.” Based on current modelling, as few as 4,000 or as many as 44,000 deaths may now be expected. 
• Life will begin to resume some normalcy in Quebec beginning May 4, Premier Francois Legault said yesterday (04/28.) Retailers outside greater Montreal may begin reopening next Monday (04/04) beginning with the manufacturing and construction sectors and non-mall retailers. Those categories will open in Montreal the following week. Mall retailers, restaurants, cultural centres such as concert halls, and personal grooming places will remain closed. Said the premier: "Our challenge is to gradually restart the economy without restarting the pandemic." The province plans to reopen schools beginning 05/11.
• Speaking of paradoxes, Britain's Economist newspaper reports one unexpected consequence of measures introduced to curtail deaths from Covid-19 is a big jump in deaths from non-Covid causes, because patients are afraid to visit hospitals, and a large increase in deaths outside hospitals, notably in long-term care facilities. Data from the U.K. Office for National Statistics suggest that many more are dying both of other causes (as trips to hospitals are put off) and outside of hospitals (often in care homes). On the week ending April 3, there were 16,387 deaths, a third higher than normal. The Economist faults Sir Patrick Vallance, the government’s top scientific advisor, who recommended in early March that churches and other public events should stay open, despite other European companies deciding otherwise.
• Physicians are front-line responders to the pandemic, and therefore heroes of this moment, deserving of everyone's respect, right? Well, maybe not so much at TD Canada Trust. Dr. Coleman Rotstein, a transplant specialist and University of Toronto medical school prof, tells CBC News he was told he isn't welcome in his midtown TD branch... because he's a health worker. Likewise, his wife isn't allowed inside the bank -- because she's also a doctor. And how do the doctors Rotstein regard being excluded from their financial institution? "It's a slap in the face," he says. A spokesperson for the bank, reached by reporters, says they'll "share this customer's feedback with our team." Meanwhile, an Arizona politician is encouraging demonstrators gathering in defiance of the state's shelter-in-place guidance to mockingly wear HCP's attire of scrubs and masks. Just as the number of Covid-19 cases passed one million in the USA, former state senator Kelli Ward urged the pinhead protestors to dress as doctors, tweeting that "the media doesn't care.” Sure, that’s an egregious affront to front-line heroes, but consider this:  Ward happens to be a doctor herself.

RIGHT NOW I’M LISTENING TO

The commercial for J.D. Wentworth that plays continuously throughout the day on cable TV. Who or what is J.D. Wentworth, and why can’t I get this ridiculous tune out of my skull? What is happening to us during this lock-down, anyway?

STUFF CHRONICLE IS WORKING ON RIGHT NOW

Chronicle’s Cathy Dusome is organizing the first ever Spring webinar version of the National Pharmaceutical Congress. It’s scheduled for May 20 at 11 am, and you’re all invited. It’s a special panel discussion about what the Life Sciences business will look like once the Covid-19 crisis has calmed. (Hint: things will change.) Announcement of this event is coming in Monday’s Daily CurveFlattener, and registration will start next week. It will be free to previous NPC delegates and faculty. Watch this space.

RIGHT NOW WE ARE READING... 

I’m on a quarantine-based binge of escapist crime fiction set in Detroit. Last week it was Dutch Leonard’s novels and now it’s Loren D. Estleman – the estimable Estleman, if you like – and his 2018 Black and White Ball, featuring protagonists from two of his long-running noir series. In this yarn he sets several scenes in Canada, and I love how even as talented and successful an American writer as Estleman can’t grasp or plausibly convey north-of-border dialect, attitudes or psychology. He might have looked for clues in Richard Ford’s fine recent novel “Canada” if he wanted to do it right. Lame, Loren.

TONIGHT WE ARE COOKING... 

At the risk of sounding like, you know, one of those guys, my wife is in charge tonight, and I’ll probably hear about the menu later, on a need-to-know basis. Tomorrow I get my turn in front of the microwave, and that’s bound to offer more surprises for all concerned.

HOW ARE YOU?

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C’est ca. Stay in touch, and stay safe.