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美国著名医学期刊《新英格兰医学杂志》（New England Journal of Medicine）周三发表了一篇编辑撰写的社论，谴责特朗普政府应对新冠病毒肺炎流感大流行，并呼吁投票罢免美国现任领导层，这是前所未有的举动。

《新英格兰医学杂志》总编辑埃里克·鲁宾。图片来源：哈佛大学官网。

《新英格兰医学杂志》主编、这篇新社论主笔之一埃里克·鲁宾（Eric Rubin）博士说：“我们很少发表由所有编辑签名的社论。”。

这篇题为“濒死于权力真空”（Dying in a Leadership Vacuum）的社论，在第一段开宗明义指出：“新冠病毒已在全球制造一场危机，这场危机产生一场领导能力考验。在没有更好的选择来对抗这个新病毒的情况下，各国在如何反应上被迫做出艰难抉择。而在美国，我们的领袖未能通过考验，他们把一场危机变成一出悲剧。”

文章引用约翰霍普金斯大学的统计，首先爆发疫情的中国大陆，一开虽延误处置，但之后以严格隔离及封城等措施控制疫情传播，病故率约百万分之三。相较之下，美国的病故率高达百万分之五百以上。

文中指出：“任何以这种方式轻率草菅人命及挥霍金钱的人，将承认法律上的后果。我们的领袖声称自己的行为大多数都没错，但这场选举给我们下判断的权力。当谈到应对我们时代中最大的公卫危机时，我们现在的政治领导人表现出他们不胜任到危险的程度。我们不该放任他们，允许他们留在位子上，而让数以千计的更多美国民众死去。”

鲁宾博士说，这篇社论是8月份起草的，其中详细介绍了美国在新冠病毒病例和死亡人数方面中，如何位居世界前列的事实。到目前为止，美国已有750多万人被诊断出患有新冠病毒肺炎，超过21万人死于新冠病毒肺炎。

“这场疫情危机对领导力进行了考验。由于没有好的方法来对抗新型病原体，各国被迫在如何应对方面，做出了艰难的选择。但在美国，我们的领导人未能通过这种考验。他们把疫情危机变成了一场悲剧。”社论说。

这篇社论但对特朗普政府在新冠疫情大流行期间的领导地位，提出了严厉的批评。

社论指出：“任何人如果以这种方式肆无忌惮地挥霍生命和金钱，都将遭受法律的后果。我们的领导人基本上都声称他们的行为享有豁免权的。但是，这次总统选举给了我们做出判断的权力。”

社论还说：“在应对我们这个时代最大的公共卫生危机时，我们现在的政治领导人已经表明，他们是危险的无能为力。我们不应该教唆他们，让他们继续保住工作，从而使成千上万的美国人死亡。”

《新英格兰医学杂志》于1812年开始出版。在最近的一段时间里，以前只有四篇社论是由其编辑集体签名的：2014年一篇关于避孕的文章；同年一位前总编辑的；当年有关的社论和2019年有关的社论。

这是美国出版界第一次为总统选举发声。

鲁宾表示：“我们从来没有发表过关于选举的社论，是因为我们不是一个政治期刊。我也不认为我们想成为一个政治期刊——但是，这里的问题是围绕事实，而不是围绕意见。”

鲁宾还说：“例如，佩戴口罩所起的作用。社会疏远距离要求。检疫隔离和隔离工作。他们不是意见。决定不使用它们可能是一项政治决定，但试图暗示它们不是真实的，则是虚构和危险的。我们没有合适的领导人来应对这种新冠疫情流行病。我认为我们需要更好的领导人。”

社论亦引用华盛顿邮报及纽约时报文章，但文中未背书支持任何候选人。

在新冠疫情流感大流行期间和今年11月的总统大选之前，《新英格兰医学杂志》并不是唯一一份发表政治立场的医学或科学出版物。

今年9月，《科学美国人》（Scientific American）杂志宣布支持前副总统、民主党候选人拜登，并且批评否定科学的特朗总统。这一声明标志着该杂志175年来首次认可支持了一位总统候选人。

《新英格兰医学杂志》（THE NEW ENGLAND JOURNAL OF MEDICINE （NEJM））

出版方：美国马萨诸塞州医学会（the Massachusetts Medical Society，MMS）。

美国马萨诸塞州医学会（Massachusetts Medical Society）拥有18，500多名医生和学生会员，致力于为马萨诸塞州的患者和医生提供教育与支持。该协会出版全球领先的医学杂志之一《新英格兰医学杂志》、涵盖11大专业的专业通讯系列《Journal Watch》以及《AIDS Clinical Care》。该协会还是马塞诸塞州面向医疗保健专业人员提供持续医学教育的领导者，为医生和医疗保健专业人员举办各种医学教育项目。该协会成立于1781年，是美国持续运作历史最悠久的医学协会。

Dying in a Leadership Vacuum

Covid-19 has created a crisis throughout the world. This crisis has produced a test of leadership. With no good options to combat a novel pathogen, countries were forced to make hard choices about how to respond. Here in the United States, our leaders have failed that test. They have taken a crisis and turned it into a tragedy.

The magnitude of this failure is astonishing. According to the Johns Hopkins Center for Systems Science and Engineering,1 the United States leads the world in Covid-19 cases and in deaths due to the disease, far exceeding the numbers in much larger countries, such as China. The death rate in this country is more than double that of Canada, exceeds that of Japan, a country with a vulnerable and elderly population, by a factor of almost 50, and even dwarfs the rates in lower-middle-income countries, such as Vietnam, by a factor of almost 2000. Covid-19 is an overwhelming challenge, and many factors contribute to its severity. But the one we can control is how we behave. And in the United States we have consistently behaved poorly.

We know that we could have done better. China, faced with the first outbreak, chose strict quarantine and isolation after an initial delay. These measures were severe but effective, essentially eliminating transmission at the point where the outbreak began and reducing the death rate to a reported 3 per million, as compared with more than 500 per million in the United States. Countries that had far more exchange with China, such as Singapore and South Korea, began intensive testing early, along with aggressive contact tracing and appropriate isolation, and have had relatively small outbreaks. And New Zealand has used these same measures, together with its geographic advantages, to come close to eliminating the disease, something that has allowed that country to limit the time of closure and to largely reopen society to a prepandemic level. In general, not only have many democracies done better than the United States, but they have also outperformed us by orders of magnitude.

Why has the United States handled this pandemic so badly? We have failed at almost every step. We had ample warning, but when the disease first arrived, we were incapable of testing effectively and couldn’t provide even the most basic personal protective equipment to health care workers and the general public. And we continue to be way behind the curve in testing. While the absolute numbers of tests have increased substantially, the more useful metric is the number of tests performed per infected person, a rate that puts us far down the international list, below such places as Kazakhstan, Zimbabwe, and Ethiopia, countries that cannot boast the biomedical infrastructure or the manufacturing capacity that we have.2 Moreover, a lack of emphasis on developing capacity has meant that U.S. test results are often long delayed, rendering the results useless for disease control.

Although we tend to focus on technology, most of the interventions that have large effects are not complicated. The United States instituted quarantine and isolation measures late and inconsistently, often without any effort to enforce them, after the disease had spread substantially in many communities. Our rules on social distancing have in many places been lackadaisical at best, with loosening of restrictions long before adequate disease control had been achieved. And in much of the country, people simply don’t wear masks, largely because our leaders have stated outright that masks are political tools rather than effective infection control measures. The government has appropriately invested heavily in vaccine development, but its rhetoric has politicized the development process and led to growing public distrust.

The United States came into this crisis with enormous advantages. Along with tremendous manufacturing capacity, we have a biomedical research system that is the envy of the world. We have enormous expertise in public health, health policy, and basic biology and have consistently been able to turn that expertise into new therapies and preventive measures. And much of that national expertise resides in government institutions. Yet our leaders have largely chosen to ignore and even denigrate experts.

The response of our nation’s leaders has been consistently inadequate. The federal government has largely abandoned disease control to the states. Governors have varied in their responses, not so much by party as by competence. But whatever their competence, governors do not have the tools that Washington controls. Instead of using those tools, the federal government has undermined them. The Centers for Disease Control and Prevention, which was the world’s leading disease response organization, has been eviscerated and has suffered dramatic testing and policy failures. The National Institutes of Health have played a key role in vaccine development but have been excluded from much crucial government decision making. And the Food and Drug Administration has been shamefully politicized,3 appearing to respond to pressure from the administration rather than scientific evidence. Our current leaders have undercut trust in science and in government,4 causing damage that will certainly outlast them. Instead of relying on expertise, the administration has turned to uninformed “opinion leaders” and charlatans who obscure the truth and facilitate the promulgation of outright lies.

Let’s be clear about the cost of not taking even simple measures. An outbreak that has disproportionately affected communities of color has exacerbated the tensions associated with inequality. Many of our children are missing school at critical times in their social and intellectual development. The hard work of health care professionals, who have put their lives on the line, has not been used wisely. Our current leadership takes pride in the economy, but while most of the world has opened up to some extent, the United States still suffers from disease rates that have prevented many businesses from reopening, with a resultant loss of hundreds of billions of dollars and millions of jobs. And more than 200,000 Americans have died. Some deaths from Covid-19 were unavoidable. But, although it is impossible to project the precise number of additional American lives lost because of weak and inappropriate government policies, it is at least in the tens of thousands in a pandemic that has already killed more Americans than any conflict since World War II.

Anyone else who recklessly squandered lives and money in this way would be suffering legal consequences. Our leaders have largely claimed immunity for their actions. But this election gives us the power to render judgment. Reasonable people will certainly disagree about the many political positions taken by candidates. But truth is neither liberal nor conservative. When it comes to the response to the largest public health crisis of our time, our current political leaders have demonstrated that they are dangerously incompetent. We should not abet them and enable the deaths of thousands more Americans by allowing them to keep their jobs.

来源时间：2020/10/8   发布时间：2020/10/8

旧文章ID：23160