Florida Gov. Ron DeSantis has found his ideal ideologue in Dr. Joseph Ladapo, whom he appointed this week as Florida’s Surgeon General and head of the state’s Department of Health. (While technically he must be confirmed by the Florida Senate, this is a mere formality in the Republican-controlled legislature.) Dr. Ladapo will thus be in charge of public health for Florida’s 21-million-plus citizens (including me), running an agency of some 17,000 employees tasked with, among other jobs, the state’s response to the COVID-19 pandemic. He has also been hired by the University of Florida’s med school, which DeSantis claims is totally coincidental.
He will replace Dr. Scott Rivkees, the current state Surgeon General, who has resigned. Dr. Rivkees, a pediatric endocrinologist, has been sidelined by the DeSantis administration, presumably because he refuses to go along with DeSantis’s policies. The Deputy Secretary of Health has also resigned.
Dr. Ladapo does not have a background in public health and has never been in charge of so much as a department at the UCLA Geffen School of Medicine where, prior to his appointment, he was an associate professor and health policy researcher “whose primary research interests include assessing the cost-effectiveness of diagnostic technologies and regarding the population burden of cardiovascular disease”, according to his UCLA bio (which was just taken down). He has an MD and PhD in Health Policy from Harvard and is board-certified in Internal Medicine.
While obviously qualified in his particular area, it is equally obvious that he is not the most qualified person to head the public health agency of the country’s third largest state. In my view, the only reason he got the job is because DeSantis needed window dressing for his anti-science views on managing the state’s COVID response. In this regard, Dr. Ladapo is eminently qualified. Dr. Ladapo is both a member of the fringe medical group “America’s Frontline Doctors” and a signatory to the Great Barrington Declaration, which we’ll return to in a moment.
Dr. Ladapo proved his loyalty to DeSantis on his very first full day in office by issuing an “emergency” rule giving parents sole discretion over whether their children wear masks at school. The rule also says that if a student has been exposed to COVID-19, parents can choose to keep their children in school “without restrictions or disparate treatment, so long as the student remains asymptomatic”.
A research scientist at the University of Florida’s department of biology and the Emerging Pathogens Institute told the Miami Herald that
asymptomatic people are a ‘major source’ of COVID-19 transmission. He said transmission can occur with people before they develop symptoms or with people who never develop symptoms.
The CDC recommends that students who are not fully vaccinated and are exposed to someone with COVID-19 get tested and be quarantined at home for 14 days after exposure, regardless of their test results.
Issuing the “emergency” rule was a clever political ploy that killed two birds with one stone. By replacing DeSantis’s previous ban on mask mandates, it automatically mooted at least some of the court and administrative challenges filed by school districts and parents against that ban. They will now have to file completely new lawsuits challenging the new rule. And by issuing an “emergency” rule, the Department of Health circumvented all the usual requirements of notice to the public and possibly a hearing before the rule could be implemented.
Dr. Ladapo continues the DeSantis tradition of listening only to “experts” who happen to agree with him, like Drs. Scott Atlas and Jay Bhattacharya, whom DeSantis chose as his expert witness in the recent case he lost over mask mandates.
At the press event announcing his appointment, Dr. Ladapo said he would “reject fear” as a public health strategy, saying fear has been “something that’s been unfortunately a centerpiece of health policy in the United States ever since the beginning of the pandemic, and it’s over here”.
He accused unspecified “scientists” of “taking the science and basically misrepresenting it to fit their agendas”. This is from a person who, as you will see, has repeatedly been involved in misrepresentations of science, has raised unwarranted fears about the COVID-19 vaccines, and most definitely has an agenda.
When asked whether Florida should be promoting vaccination, Dr. Ladapo said that too much emphasis had been placed on that approach, that it’s “been treated almost like a religion and that’s just senseless”, and that the state should be supporting several measures for good health: “vaccination, losing weight, exercising more (and) eating more fruits and vegetables”, which made it sound like he was promoting eating vegetables as the equivalent of vaccination. He acknowledged that the COVID-19 vaccine “prevents the risk of serious illness” but said
People get to make the choice about what they want to do with that information.
Yep, and the rest of us just have to live with the consequences.
DeSantis chimed in that “telling the truth is important” and that
You’ve got to tell people the truth and you’ve got to let them make their decisions.
This is interesting sentiment from a governor who has repeatedly lied about the effectiveness of masks, falsely stating that they don’t work, that they cause disease and developmental issues in children, and that they interfere with breathing. He also relentlessly promoted hydroxychloroquine, despite the lack of evidence, going so far as to cop a million doses of the stuff, most of which sat unused. His promotion created a run on the drug, which infuriated rheumatologists, whose patients need hydroxychloroquine as a legitimate treatment for lupus and rheumatoid arthritis. Oh, and he recently stood by silently while a speaker he’d invited to weigh in against vaccine mandates falsely claimed that the COVID vaccine “changes your RNA”.
Given extraordinary powers over public health by the legislature, DeSantis has banned mask mandates, vaccine mandates, “vaccine passports” and, except for very early in the pandemic, has rejected shutdowns as a means of virus control. He has, of late, de-emphasized vaccination and continued his policy of fully opening up the state, his strategy being to set up monoclonal antibody clinics and treat the disease instead of preventing it. He has positioned himself as the anti-Fauci and fundraised via the sale of sophomoric merchandise like “Don’t Fauci my Florida” tee shirts and anti-mask beer koozies.
None of this has worked out well for the citizens of Florida.
Florida saw a terrific surge in cases, hospitalizations, and deaths over the summer, with nearly 20% of tests coming back positive. As of September 22nd, Florida has the second highest COVID-19 death rate in the nation. About a month ago, we also had the nation’s highest hospitalization rate. Our percentage of people fully vaccinated is just under 57%, 21st in the nation.
With that, let’s turn our attention to some interesting background information on my new Surgeon General.
America’s Frontline Doctors
The COVID pandemic has brought the kooks out of the woodwork and, in a crowded field, none kookier than Dr. Stella Immanuel, one of the founders of the fringe medical group, America’s Frontline Doctors, which is affiliated with the right-wing organization Tea Party Patriots Action. She has famously claimed that “tormenting spirits” are responsible for “serious gynecological problems” and impotence, and that “many women suffer from astral sex regularly”, “astral sex” being “the ability to project one’s spirit man into the victim’s body and have sex with it” which is “very common among Satanists”.
Dr. Immanuel was a speaker at an America’s Frontline Doctors-sponsored “White Coat Conference” held last year on the steps of the U.S. Supreme Court, although the Court had nothing to do with the event. She falsely claimed that hydroxychloroquine, zinc, and Zithromax were “cures” for COVID-19. (This and other misinformation caused a video of the event to be pulled from social media.) Also speaking was Dr. Simone Gold, who later distinguished herself by participating in the January 6th insurrection, going so far as to enter the Capitol Building, which had conveniently been opened up for her by thugs smashing through the windows and doors and overcoming the Capitol police. This got her both arrested and fired from her job. Among other crackpot statements, Dr. Gold has claimed that the COVID-19 vaccine is actually an “experimental, biological agent deceptively named a vaccine”.
And guess who else put in an appearance at the “Conference”? Florida’s new Surgeon General, Dr. Ladapo, himself a member of America’s Frontline Doctors.
In addition to his work with America’s Frontline Doctors, Dr. Ladapo has written a series of opinion pieces for The Wall St. Journal that, to borrow a phrase, have taken the science and basically misrepresented it to fit his agenda. Each one could probably merit its own post, so I’ll limit our review to a few highlights.
A June 22, 2021 WSJ Commentary by Dr. Ladapo and a co-author carried the clickbait headline “Are Covid Vaccines Riskier Than Advertised?”, with the subhead “There are concerning trends on blood clots and low platelets, not that the authorities will tell you”. A better title would have been “Anti-Vaccination Talking Points”, perhaps with the subhead “Things THEY don’t want you to know”.
Basically the authors claim that there is a government cover-up of adverse events from the COVID-19 vaccine, even though the data they looked at to support this assertion was government-published adverse event reporting, the VAERS database. Speaking of “agendas”, they say that “the silence around these potential signals of harm reflects the politics surrounding Covid-19 vaccines”, even while admitting that this government-published data cannot demonstrate a causal link between a vaccine and a claimed harm. They then say that “stigmatizing such concerns is bad for scientific integrity and could harm patients”, a “stigmatization” they apparently fabricated. If the government isn’t saying anything, as they charge, how can it be “stigmatizing” anyone’s “concerns”?
They then dress up a Norwegian Medicines Agency report on death following vaccination in the frail elderly as a “sign of life for scientific honesty” just so they can throw in some scary statistics, which, as Dr. Gorski explained in a post on anti-vaccination fear-mongering, aren’t so scary after all.
In any event, their claim of “silence” around the four potential adverse events they highlight (thrombocytopenia, myocarditis, deep-vein thrombosis, and death) is nonsense. The CDC has posted information on all of these; for example, here, here, here, and here.
In his WSJ columns, Dr. Ladapo has continually flogged ivermectin and hydroxychloroquine, writing as recently as September 16th that the evidence regarding these drugs is “unsettled”, citing (and linking to the website of) the self-declared Early COVID Care Experts group, because they “have reported low rates of hospitalization and death when using these therapies”. In other words, anecdotal evidence trumps clinical trials. The Early COVID Care Experts include (in addition to Dr. Ladapo himself), conspiracy theorist Dr. Peter McCollough, who falsely claimed that COVID vaccines have killed up to 50,000 people, that vaccines don’t protect against the delta variant, and there’s no clinical reason to go get vaccinated. He was recently sued by a Baylor University health system affiliate to stop him from claiming he is associated with that institution because of “irreparable reputational and business harm” to the institution.
Another member is Dr. Victor Zelenko, whose claim that his cocktail of drugs, including hydroxychloroquine, was “100% effective” was apparently a factor in former President Donald Trump’s embrace of this “miracle” cure.
Other of his commentaries have attacked mask and vaccine mandates. The latter, he says, “can’t end the spread of the virus as effectiveness declines and new variants emerge” and “are not 100 percent effective at preventing a vaccinated person from spreading the disease”. While it is true that mandates may not “end” the pandemic, they certainly do help prevent the spread of the virus and keep people out of the hospital (as he admits). Why make the perfect the enemy of the good? No intervention is 100% effective, but that doesn’t mean we shouldn’t at least consider using it.
In attacking mask mandates (which is really an attack on mask wearing itself) he claims that “most [trials] have shown that wearing a mask has little or no effect on respiratory virus transmission”. This is simply untrue.
If there is one consistent theme running through his WSJ columns, it is that things he doesn’t agree with (e.g. masks) are not supported by sufficient evidence, no matter how strong the evidence is in their favor. At the same time, the things he does agree with (e.g., ivermectin), he contends, are being rejected just because they are not “certain”, even when they, in fact, have sufficient competent evidence to reject their use. It’s almost as if the more evidence there is, the greater his objection, while the less evidence there is, the more enthusiastic he becomes.
Finally, there’s Dr. Ladapo’s signature on the greatly problematic Great Barrington Declaration, the central thesis of which is that we should lock down only the most vulnerable and let everyone else go about their business until herd immunity is reached. (He has since backpedaled somewhat, saying there were “a couple of things” he didn’t agree with, although we don’t know which ones.) The Declaration, which was backed by a libertarian think tank, and which anyone could sign, was roundly criticized by epidemiologists and other experts. There were a number of reasons for this, which Dr. Gorski covered extensively in his post on the subject, but the main reason was, according to epidemiologists, it was unlikely to work. It was also highly dubious ethically.
Back in 2016, Dr. Ladapo wrote an opinion piece for The Washington Post about the valuable lessons he learned from his wife’s unfortunate experience with what he describes as a chronic, debilitating illness. Lesson No. 2 is “Don’t be afraid to ask for a specialist”.
This experience [finding effective pain relief for his wife] reiterated how important it is to bring in specialists. As an internist, most of my training in pain management happened on the job while caring for patients with cancer. Though I picked up strategies from more experienced nurse practitioners and physicians, I don’t have nearly the expertise of specialists, who receive formal training in a range of interventions and therapies. They also spend more time with patients suffering from chronic, painful conditions and learn through these interactions how to better aid their suffering.
It is sad that Dr. Ladapo fails to recognize the need for humility and respect for those with greater expertise now. He has no expertise in public health, epidemiology, virology, or infectious diseases, yet he has, over and over, scorned the advice of those who do.
Perhaps as the weight of his new job as protector of the public health settles in, his willingness to pontificate about matters outside the scope of his education and training will abate and he will again have the wisdom to listen to those with the formal training and experience necessary to effectively combat the pandemic. Of course, if that happens, he will likely be out of a job, just like Dr. Rivkees. Only time and Florida’s COVID stats will tell.