The Covid-19 pandemic gave rise to an expert class of media-friendly doctors whose broadcasted health guidance has ranged from life-saving to bewildering. Prominent among these is Dr. Leana Wen, best known for punditry in a wide variety of outlets, including CNN and the Washington Post. Wen is a self-styled physician-advocate, dedicated to addressing the “social determinants of health” — non-medical factors like education, income, and housing, which nevertheless dramatically affect individual and population health. With a long, extraordinary career involving stints as a faculty member at George Washington University, the president of Planned Parenthood, health commissioner for the city of Baltimore, president of the American Medical Student Association (AMSA), and a Rhodes scholar, Wen appears on paper as a physician-advocate par excellence — one with the right background, motivation, training, experience, and power to effect real change in the interest of health justice.
How, then, did Wen end up as one of the most reliable mouthpieces for the Biden administration’s inhumane mass infection political strategy?
To trace this evolution, one can look to the early years of Wen’s life and career. Her childhood was a hard lesson in the realities of injustice and inequality, with her family undergoing extreme hardship — financial, medical, and familial — following their emigration to the United States from China. As Wen details in her 2021 memoir Lifelines, these formative experiences, including her mother’s diagnosis and subsequent death from metastatic cancer caught too late as a result of medical negligence, cemented Wen’s commitment to opening the “Pandora’s box” of the social causes of health and disease. “If what was making my patients sick was the health-care system itself, wasn’t it my obligation to fix the system?” she writes.
“If what was making my patients sick was the health-care system itself, wasn’t it my obligation to fix the system?”
While early episodes in Wen’s life instilled her professional dedication to health justice, they also shaped a worldview that tends to undermine her progressive vision. This worldview is characterized by two qualities, especially evident during the pandemic: an accommodating pragmatism that can adapt to (or legitimize) suboptimal circumstances, and a diligent careerism that can allow expediency to override values or principles.
The concept of pragmatism appears time and again through the arc of Wen’s career, borne from the necessity of adapting in order to survive the rigid, conservative, and hierarchical reality of medical training. In her book, she recounts one of her earliest experiences of advocacy: the American Medical Student Association’s “PharmFree” campaign, launched in 2002 with the aim of moderating the harmful influence of the pharmaceutical industry on medical training and practice. Perhaps elucidating her later thinking, she concludes that pragmatism and incremental reformist approaches, rather than “extreme” approaches from “the progressive flank” of the medical student association (meaning advocacy against engaging with corporate entities like Purdue Pharmaceuticals) were the key to the campaign’s success at, for example, strengthening conflict-of-interest disclosure requirements.
This tendency to favor pragmatic compromise over more radical alternatives also shapes Wen’s outlook on policing as a social determinant of health. During her time as Baltimore Health Commissioner from 2014 to 2018, Wen and her team maintained close interactions with Baltimore police (including police escorts for safety). This informed Wen’s views of law enforcement as indispensable partners in public health. Throughout Lifelines, Wen references the 2020 police murder of George Floyd and states flatly that abolishing or defunding the police is “not practical” and that such radical approaches represent a “luxury” that doctors on the “front lines” like herself can ill afford. While she has rightfully highlighted the dire public health effects of racism, she fails to acknowledge a growing body of critical public health scholarship that says policing is not only an institution of racism, but also a source of “morbidity and mortality” in its own right. Notwithstanding this scholarship, while Wen advocates for nonspecific “reforms” to the criminal-legal system, fundamental change is, in her view, simply not feasible.
In 2018, Wen left Baltimore to accept a new job as the sixth president of Planned Parenthood — the first Asian-American woman and the second doctor to ever hold the role. Less than a year later, Wen was dismissed from the position, with a flurry of news reports describing differences in vision and strategy for the organization. The most insurmountable differences derived, in part, from her center-aisle approach to business; Wen’s vision, in her telling, was to depoliticize abortion by rebranding Planned Parenthood as a general health-care provider. In Lifelines, this is framed as a concession to sensible moderates, based on her previous interactions with some Title X grant recipients who were leery of attending meetings where Planned Parenthood would be present. “If Planned Parenthood was seen as too controversial,” Wen writes, “then reproductive health was at risk of becoming even more cut off from the rest of health care.”
Wen’s goal was to resituate abortion within the spectrum of “regular” health care, but she confused cause and consequence: abortion is siloed off from other health care precisely because it is so politicized, and it is politicized because of fundamental values conflict over reproductive autonomy. Thus, with longstanding political conflicts increasingly placing reproductive rights at jeopardy, the head of the single largest provider of reproductive health services in the nation was busy placating a phantom constituency of moderates.
Highlighting Wen’s preference for pragmatism and compromise does not detract from the good, even transformational work she has done in the realm of public health. In Baltimore, she implemented a number of commendable, innovative programs, particularly in overdose prevention and improvement of behavioral health treatment services; notably, her health department was one of the first in the country to issue a standing order for the overdose-reversal drug naloxone, making it freely available from any pharmacy without a prescription.
From the onset of the Covid-19 pandemic, which arrived shortly after Wen left Planned Parenthood for a faculty role at George Washington University, people looked to her for reasonable guidance with a mildly liberal bent, counterposed against the Trump administration’s recklessness. With her impeccable credentials, coolly professional demeanor, and willingness to put a moderating spin on difficult current events, she quickly became one of the most high-profile and sought-after commentators in the country. Wen reasoned that adapting to a difficult new reality was an acceptable price to pay to avoid unacceptable levels of death — here, her pragmatism and adaptability coincided with fundamental public health principles. In another example of the sometimes-suitability of her pragmatism, Wen condemned the premature reopening of non-essential businesses and services in the summer of 2020 (explicitly blaming Trump’s leadership) while simultaneously offering practical guidance for business leaders on strategies to minimize risk. Given the suboptimal circumstances created by federal and state policy, Wen asked how harms be could be reduced.
Wen’s common-sense advocacy continued into Biden’s term, albeit with a lot more deference. Moving away from the language of blame or condemnation that she had used during the Trump administration (for example, tweeting that if Trump had been under her care during his October 2020 coronavirus infection, when he famously took a widely condemned car ride, she would have referred him for a psychiatric evaluation — after, of course, “calling security to restrain him”), Wen’s rhetorical style became more constructive and conciliatory, although she still aired critiques of the Biden administration’s plans from time to time.
But starting sometime in late 2021, Wen’s tone shifted from one of precaution and compromise to one of eager capitulation to the Democrats’ latest bullshit line (the most common being that “we have the tools” to manage the pandemic without comprehensive federal policy). She went from cautioning against gatherings to praising the April 2022 Gridiron Club dinner, tweeting: “The Gridiron Club dinner was probably a #Covid-19 superspreader. But events like this should still go on. This is our new normal.” (That dinner dinner did, in fact, turn out to be a superspreader event.) Her tune regarding school closures also changed; by January 2022, she was arguing that “Omicron is not a reason to keep schools closed,” despite the evidence establishing risks of in-school transmission, strain on pediatric hospital capacity when transmission is not mitigated, and the potential for children to experience severe outcomes of Covid infection including death. Where 2021 Wen insisted that people should not have the “choice” to expose others, 2022 Wen eschews government intervention and widespread policy in favor of shifting the onus to individuals’ private choices.
Wen’s stated endpoint for caring about Covid was with the arrival of the highly transmissible Omicron variant in December 2021, she admits in an April interview with STAT News. “I’m quite convinced,” she said, “that everybody is going to get BA.2, if they have not gotten omicron, in the near future.” Like much of Wen’s Covid advocacy, this was couched in an annoying rhetorical question: For “people who are saying it’s not time to remove mask mandates,” she asks, when is your endpoint, if not now?
The most assured path to continued success and prestigious opportunities is to mold one’s public advocacy to a pre-formed consensus.
There is simply no satisfactory answer to this question. The pandemic is out of control, and vaccination rates remain stagnant, while omicron continues to mutate into hypertransmissible variants that evade partial immunity from vaccines or prior infection. Covid infection can be devastating; neither the array of long Covid symptoms nor the financial consequences of symptomatic illness or post-viral chronic conditions are “mild,” for individuals or society. Hospitalizations are currently rising behind the latest, largely invisible wave of infections. In the context of uncontrolled transmission, multiple reinfections per year are essentially guaranteed. These are the scientific facts that make some kind of coherent federal Covid-prevention strategy — continued masking, at minimum — a necessity.
But the Democratic Party are simply tired of accommodating themselves to a pandemic that is mostly killing other people; namely those who don’t have the luxury of choosing occupational exposure. That these are the very people that Wen has claimed to champion does not seem to matter. She is less a physician-advocate figure now than a careerist one, on call to help the Biden administration massage their disastrous messaging. This is a pragmatically ambitious approach. Rather than telling uncomfortable truths, the most assured path to continued success and prestigious opportunities is to mold one’s public advocacy to a pre-formed consensus. Seen this way, unshakeable principles are actually a hindrance — the kind of “extreme” luxury that a truly serious person can ill afford.
Adaptability may be one of Wen’s strengths, and she has proven herself capable of adapting to a depraved political climate that bears disastrous consequences for health — all the while insisting, from a position of tremendous influence, that this is the best we can do. Far from “meeting people where they are” (one of her favorite maxims), this stance represents a fundamental disrespect: a doctor’s patronizing insistence that we must accept political failure and the extremely high levels of preventable death it entails. Wen’s approach is a concrete response to the realities of the world, but it’s also, in many cases, a concession — a failure of imagination that circumscribes any vision of a more just future when we need it most.
Abby Cartus is an epidemiologist and a postdoctoral researcher at Brown University, where her work focuses on perinatal health and overdose prevention.