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Ada County doctor interviews: ‘Two sides of the coin’ on public health

Ada County Commissioners interview Dr. Stanley Moss, one of three applicants for a physician seat on the Central District Health board.

Commissioners will vote Tuesday on their choice for the Central District Health board

Three local doctors had 30 minutes each to sell themselves as the best choice to join the Central District Health board during a series of interviews Monday before the Ada County Board of County Commissioners.

Commissioners Rod Beck, Ryan Davidson and Kendra Kenyon will vote Tuesday on their nominee for the position — the only licensed physician on the board. Residents can watch the meeting on the county’s YouTube page.

The candidates: Dr. Sky Blue, a local epidemiologist and infectious disease specialist; Dr. Ryan Cole, a pathologist who owns Cole Diagnostics laboratory; and Dr. Stanley Moss, a retired orthopedic surgeon.

The interviews touched on a range of topics — the candidates’ experience with budgets, their interest in routine public health, and their opinions on the pandemic, COVID-19, preventive measures and the balance between a community’s health and an individual’s choices.

The commissioners have received thousands of public comments, supporting or opposing Cole or Blue, mostly from dueling email campaigns by the Ada County Republicans and The Idaho 97 Project.

Ada County residents and health care providers have endorsed both Blue and Cole. The overwhelming share of support from the Ada County medical community went to Blue, while Cole mainly drew praise from Ada County residents who voiced concerns about vaccines, masks and COVID-19 measures.

Here are some highlights:

Politics and health, and the politics of health

While questioning the candidates, Kenyon and Davidson brought up political polarization. So did the candidates themselves.

“The problem (with COVID-19 vaccines) is that it’s become not so much a medical issue, it’s kind of shifted to that political issue,” Moss said. People have concerns, but “most of those concerns are based on misinformation,” he said.

He said “the key is to educate the people and then let them make the correct choice. I don’t believe in coercion, I don’t believe in threats.”

Kenyon said of the pandemic, “instead of dividing us, it should bring us together.”

Cole agreed with her. He said the coronavirus “doesn’t care what party you’re from.” He said he sees it as a “prime opportunity to re-emphasize and put public health at the forefront.”

He previously has derided public health officials, such as calling the Centers for Disease Control and Prevention the “ministry of truth,” a reference to the propaganda arm of a totalitarian regime in the political novel “Nineteen Eighty-Four.”

Kenyon said Blue has been “painted into having a political position” by others. Blue said he takes a scientific approach to health-related decisions: “looking at what the question is, what we’re trying to do, and what can inform us?”

Davidson told Blue the board is looking at “two sides of the coin” — science and facts, and the politics of what the government does about science and facts. Blue said he would “challenge your premise” and that CDH’s mission is “to promote and protect the health of those communities.”

Blue said he thinks a public health board should tell the public how it arrived at a decision, sharing the data and rationale that led to it. “Nothing is ever black and white,” he said.

Vaccines: Yes or no? Mandates: Yes or no?

The commissioners did not question Cole about his public comments on COVID-19, the vaccine or his decisions to prescribe ivermectin to patients in other states and champion its use. The anti-parasite drug is specifically not recommended by health officials in the U.S., Europe and elsewhere.

Central District Health oversees the distribution and in some cases administration of vaccines, including the COVID-19 vaccine.

Cole recently called that vaccine “a poisonous attack on our population, and it needs to stop now.” The speech, delivered to a fringe group of physicians who disseminate disinformation about the COVID-19 vaccine, also included several factual errors and misrepresentations.

“Delta has escaped what we are doing. We need to societally pivot right now,” he told the commissioners Monday. “We’re giving a vaccine right now for something that was four variants ago.”

He then alluded to ivermectin as a prevention drug.

Cole referenced some of the criticism he’s received from other Idaho medical providers, including some who submitted public comments to the commission. He said he believes they spoke out against his claims about COVID because they are beholden to Idaho health systems’ interests and financial interests. “I’m an independent physician,” he said. “Follow the money.”

Blue also is an independent physician. Moss is retired.

“Health freedom is critically important,” he told the commissioners. He said some of the early reactions to COVID-19 were reasonable but in retrospect, “we see who’s being affected the most. Let’s protect those.”

That approach to herd immunity, protecting only the most vulnerable, has proven untenable. Despite protective measures in nursing homes and long-term care facilities, outbreaks sickened and killed hundreds of Idahoans until vaccines began to roll out to those centers.

Blue and Moss said vaccinations are the escape route from the pandemic. They praised vaccines as one of the most effective public health measures.

“If we had to look at a tactic to promote and protect the health of our communities, you have to look at vaccination,” Blue said. “Vaccines throughout our history have been life-saving measures in many many different ways.”

“The only thing that is going to end the pandemic is when everyone is immune to it, or the vast majority of people are immune to it,” Moss said. The best way to achieve that is through safe and effective vaccines, he said. “Natural” herd immunity through infection would also achieve immunity, but it would kill and harm many people, he said.

He noted that almost all doctors in the U.S. have been vaccinated, but overall vaccination rates remain low in the U.S. “If the general population had the same information and confidence in the vaccine, that rate would be much higher,” he said.

How to make the Boise area healthier?

The commissioners asked the candidates how they would go about getting the public on board with healthy choices.

Kenyon at one point said “we have one of the most obese, unhealthy communities I’ve ever seen.”

But Idaho and particularly Ada County tend to score well on health metrics, with some exceptions.

All three candidates stressed education.

Kenyon asked Moss how, as an orthopedic surgeon, his experience and knowledge lends itself to public health. Moss said he knows the dynamic of local health care and its institutions. He could “explain some of the issues” and nuances of health, “because there’s a lot of misinformation and a lot of fraudulent information that is circulating around the country and our community.”

Cole said he sees “broad patterns” of health and wellness in the community through tests that go through his lab.

“We are metabolically unwell to a high degree within our community,” he said. He sees that in tests results for diabetes, cholesterol and other markers of poor health.

But what if that doesn’t work?

“Would incarceration be on the table for you? Would you draw the line there?” Davidson asked Blue.

“It certainly seems like an extreme measure, and I would expect an extreme circumstance to even have that brought up,” Blue said.

Beck asked the candidates whether people should look to their own doctors for medical guidance, or if they should look to a public health agency.

“If an individual has a health issue, I think communicating with their doctor for specific advice” is important, Blue said.

Davidson told the candidates that some people saw the CDH board’s decisions last year around the pandemic as overly restrictive. He asked their opinions on individual liberty and personal freedom.

Moss said he believes in freedom, liberty and personal choice. “The other side of that is that we do have some responsibility to keep society flowing smoothly,” he said. But an “overriding principle” must be individual freedom, choice and self-reliance, he said.

Referring to stay-home orders and other actions to slow the spread of the coronavirus, Moss said there was “a lot of collateral damage from that policy, but it probably did save some lives.”

The nuts and bolts of Central District Health

The pandemic has commanded much of the public health district’s attention. But, as several people pointed out during the interviews, COVID-19 will not be a crisis forever. The board seat is a five-year term, and the board’s usual duties include choosing the CDH director and making budget decisions for a large agency.

Blue, Cole and Moss all said they weren’t familiar with the CDH budget, its workforce or how much of its funding comes from local taxpayers.

They instead described their experiences with making such weighty decisions.

Blue cited his experience running a local HIV clinic with a $900,000 budget. It required applying for competitive grants and watching how every dollar was spent, he said.

Moss cited his experience as a vice president for the local Boy Scouts organization. He didn’t make budget decisions, but he was involved in determining priorities, he said. He also served as a president of a homeowners’ association.

The CDH budget is “not in my wheelhouse,” Cole said. But his laboratory has 80 employees, he said. “At the end of the day, that decision (about the budget) comes to me.”

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