Fauci on fall election: "I think it's very clear where I would go."

That and other stories in "Five on Friday" for July 26, 2024...

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Here we go…

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Item 1: Fauci on the next pandemic…and the next election.

The first installment of my recent Q&A with Dr. Anthony Fauci is now live on MedPage Today. You can check it out here.

We covered a lot. I asked Dr. Fauci whether or not we’d ever have another major shutdown/shelter-in-place, were there to be another Covid-19-like pandemic. (Answer: Maybe, to some degree.) I also asked him about whether he thought President Biden handled his recent Covid-19 illness correctly, given that he more-or-less ignored the CDC guidance (albeit, by doing more isolating than the officially recommended guidelines).

But in this first segment of our interview, I did dig into politics. The reason is that for over five decades, Fauci has remained steadfastly non-partisan, serving both Republican and Democratic administrations with distinction. More than that, in his book On Call: A Doctor's Journey in Public Service, Fauci goes to great lengths to emphasize the achievements he is proud of from working with both Red and Blue administrations—in particular George W. Bush’s PEPFAR (AIDS relief) program that has saved millions of lives in Southern Africa.

But later in the book, a reader finds Dr. Fauci increasingly exasperated with the far Right’s break from reality (starting in 2014 or so), its crumbling support for science, and its general bad-faith behavior. So I asked him point blank whether he could ever support former President Trump in this next election, especially in light of certain advisors that Trump brought to the White House late in his term during the Covid-19 pandemic.

Here’s that part of the exchange…

Faust: I know you're not going to say anything, but I have a hard time believing you would vote for people who are anti-vaxxer, or who cohort with anti-vaxxers.

Fauci: Yeah. I mean, that's a reasonable assumption, Jeremy.

Faust: But I think that the kinds of people who ended up in the White House towards the end of your tenure in that Trump administration—Scott Atlas, people who really didn't believe in the science you believe in—could you see yourself voting for a Trump administration?

Fauci: Again, I'm not going to talk about who I'm voting for. I think it's very clear where I would go…

This is about as close to a political endorsement as we’re going to see from Tony Fauci. I point this out not because I believe it somehow reveals political leanings that Dr. Fauci has managed to keep mum during his storied career. Rather, by him even saying this, I take it as an acknowledgment of his own disappointment with just how far off the deep-end a large segment of the Republicans (in DC, anyway) have gone.

I’ll share the other segments from our wide-ranging interview as they go live, including several questions suggested by Inside Medicine premium subscribers.

Item 2: HIV breakthrough. Injectable medication prevented 100% of infections.

A new study in the New England Journal of Medicine shows that recipients of a twice-yearly injectable HIV antiviral medication Lenacapavir had zero HIV infections. In other words, the prophylactic drug completely eliminated the risk of infection in at-risk young women. The study compared rates to the background rate of HIV infection among study volunteers, as well as oral prophylactic regimens. This is a massive finding, which apparently led to spontaneous applause—and even tears of joy—at an infectious diseases conference where the data were presented. The challenge now? Cost and getting more people interested. Injectable medications like Lenacapavir have to be administered in healthcare settings, and access is always an issue. As ever, medications only work if they are affordable and obtainable. Still, this is an amazing moment in the HIV story.

Item 3: What I’m reading: VP Harris on healthcare.

Back to politics. Now that Vice President Kamala Harris is set to be the Democratic nominee for President, her views on the issues are starting to take center stage. A MedPage Today story summarizes where Vice President Harris stands on key healthcare issues. Nothing too surprising, though Harris’s support for abortion rights is something she’s been more overtly unapologetic about than ever her current boss. On healthcare access, Harris’s 2019 position can best be described as “Medicare for all plus private insurance.” And respecting drug pricing, Harris has in the past supported caps for certain medications (like $35 for insulin) and generally enhancing the federal government’s ability to find ways to lower prices.

Item 4: CrowdStrike and hospitals.

Hospitals were not immune from the CrowdStrike outage last weekend. I was not working clinically during the event but many of my colleagues reported that the experience of having our electronic medical system down was extremely difficult. Not only do we order tests and medications on our computers, but even tracking who and where patients are became a challenge.

I’ve sometimes noticed that when our system (Epic) goes down for a couple of hours (usually planned outages for upgrades in the middle of the night), things change for both the bad and the good. Certainly paper charts (and doctors’ handwriting) are inferior to our modern computers. But when we have "Epic” downtime for a relatively short (and planned) period, I’ve often found that our care becomes a little more thoughtful and hands-on. We order fewer unnecessary tests because it’s not quite so easy. Earlier this year, a Harvard resident physician captured much of what I would have liked to have said on this topic, in a superb essay in JAMA Internal Medicine. Highly recommended.

That said, there’s a difference between a couple hours of planned Epic downtime and a multi-day apocalypse. I’m not sorry I missed it.

Item 5: Poll of the Week.

Here are the results from last week’s poll. Thanks for your votes!

Item 5a: Poll of the Week for this week!

Now that President Biden has decided not to seek re-election, Vice President Harris is the presumptive Democratic nominee…

That’s it. Your “Friday Five!”

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