Author: Kevin Homer, MD

Kevin Homer has practiced anatomic and clinical pathology at a community hospital in Texas since 1994.

Categories
2021 COVID-19 Vaccine

Vaccine Booster Update

The FDA reshaped the vaccine landscape last week, authorizing single boosters for Moderna and Janssen vaccines, and permitting boosters from all vaccine manufacturers regardless of the initial vaccine brand.   Here is an updated vaccine chart, incorporating these changes.

The changes were discussed at the two-day Advisory Committee Meeting on Vaccines and Related Biological Products Advisory Committee, held October 14-15, 2021.  EUA applications for single boosters of Moderna and Janssen vaccines were unanimously recommended (4:26:25).  The committee heard a report on the NIH “Mix and Match” study (5:27:26), the basis for the booster interchangeability authorization, but did not vote.  After this meeting, FDA approved booster interchangeability and updated Fact Sheets for Healthcare Providers Administering Pfizer, Moderna, and Janssen vaccines.  These Fact Sheets still say there is “no information on the co-administration” of vaccines.  The rules for interchangeability between primary and booster vaccines are based on the vaccine used for the primary series.  By these rules, anyone over 18 years old can get a Moderna or Pfizer booster 2 months after an initial Janseen injection.

FDA Approval means that a drug, treatment, or medical device has been licensed by the FDA for a particular purpose.  Contrary to what you may hear, approval is not a guarantee of safety and efficacy.  Rather, it means that the item in question has been through FDA’s rigorous gauntlet designed to prevent worthless or harmful products coming to market in the United States.  Approval is different from authorization.  FDA Authorization means that a product is available by Emergency Use Authorization, also known as EUA.  The EUA process is designed to speed availability of products in the U.S. during an emergency.  “Off Label” is a term used to describe use of an approved drug or device for a purpose other than its express licensed intent. Off label use of drugs is common practice.  “Not authorized” is a term used to describe use of a drug or device which has neither been approved by the FDA nor made available by EUA.

Two key criteria for EUA are that an emergency exists, and there are no approved products to address the needs of the emergency.  The continued availability of COVID vaccines under EUA is problematic on both points.  First, as COVID-19 returns to endemic levels in many parts of the country, it’s debatable whether an emergency still exists.  Once an emergency passes, and all EUAs, including the authorizations for vaccines, should be withdrawn.  Second, there is an approved COVID vaccine: COMIRNATY.  By approving a product that is not available in the U.S., the FDA has twisted itself into a pretzel.  If the product is unavailable, it should not be approved.  If the product is approved, EUAs for the other vaccines should be withdrawn.  The FDA changes its call from heads to tails depending on how you flip the coin.  

Expect two additional significant changes in coming weeks.  The first will be the push to vaccinate children.  The second will be the definition of “fully vaccinated” to include boosters.  This will be followed by authorization for multiple boosters, meaning that you will always be just months away from losing your “fully vaccinated” status.  Vaccine passports will then be a reality in the United States.  Maybe that was the endgame all along.

Who would have thought this is where we would be 21 months ago?

Categories
2021 Philosophy Science

Belief and Knowledge

I am not a scientist, but I love science.  I am not a theologian, but I love theology and the effects of spirituality on my life.  Just like I am a practitioner of pathology, I am also a practitioner of faith.  I am enriched by both.

Religion deals with matters of belief.  Science deals with matters of knowledge.  Both address the big questions of life—”Why are we here?” “Where are we going?”—but from different perspectives.   One is not a backstop to the other.  Beliefs are not morally inferior to knowledge, just as knowledge is not morally inferior to beliefs.  Both are important, but they live in different realms.  Innocently confusing science and religion leads to superstition, ignorance, or harmful conclusions.  Deliberately confusing science and religion is a deception that robs us of material and spiritual treasures.

Falsification is a key distinction between belief and knowledge.  A scientific claim is falsifiable, meaning it must make a prediction that can be tested by experiment.  If experimental results are not what the claim predicts, then the claim is false.  But if experimentation supports the claim, it’s not necessarily true; it simply might be true.  The scientific process is a last man standing game.  The longer a claim stands, the more likely it is to be true.  At some point, when an idea becomes more likely than anything else, we call it knowledge.  But knowledge is, and always has been, what is most likely true, not what is certainly true.  We can only have scientific certainty about what is false.

Lack of certainty isn’t the only limitation of knowledge.  There are scientific horizons, and we cannot see what’s on the other side.  For example, the universe is most likely expanding, but expanding into what?  We cannot know.  If the universe is expanding, then it must have been smaller before, and even smaller before that, and so on until it’s a tiny universe holding all matter and energy.   But what happened before that?  We cannot know.  What’s outside the event horizon of light, or the gravitational horizon of black holes?  Does our physics work there?  Can alternate universes coexist?  We can hold beliefs about these things, but these questions are not in the realm of science.  We have no applicable knowledge because we have no power to observe.

Science has significant limitations.  We can never be certain about what science tells us, and there are some questions that are not open for scientific investigation.  Religion also has limitations, but different ones.  Religious claims do not have the requirement of falsification.  Omnipotence is the ultimate answer for all religious questions.  When there’s no experiment that can demonstrate an idea to be false, it cannot be science, but it can be religion.  Science requires falsification; religion requires faith.  Faith and beliefs are good things.  They give us hope, purpose, and compassion.  Science cannot.

Despite its limitations, science is a powerful tool that augments our understanding of reality.  We cannot rely on science to give us quick answers, so during this pandemic, we must have faith—lots of faith.  But we also must speed science along by testing as many ideas as possible, all at the same time.  A pandemic response that clings to ideas which are demonstrably false and dismisses competing ideas without experiment is not based on science.  It’s religion pretending to be science, and it’s dangerous.  There are three explanations for nonsense disguised as science: foolishness, greed, and evil.  I fear that all three are now hopelessly entangled.

Religion and science have important roles in our fight against the pandemic.  Understanding the difference between them is a protection against deception.  When someone says, “believe in science,” beware of fraud.  Your life, your liberty, and your sacred treasures are at risk.

Categories
2021 Philosophy Science

Stop Calling It Science

Medicine is my professional life.  Science is the language of medicine, or at least it used to be.  I’m not a scientist; I’m a practitioner.  But I love science, just like I love ideas.  Ideas separate humans from other living organisms, and ideas are often played out in the arena of politics.  I am not opposed to politics, but I am opposed to deception.  It is deceptive to hide behind the label of science to cover political actions.

I don’t believe today’s misuse of science is accidental.  Those doing it are too smart and too well educated to make that mistake.  Phrases like “follow the science” and “scientific close call” give an air of legitimacy to policies that are driven by agenda rather than facts and knowledge.  Counter examples are ignored; theories are not allowed to be disproven.

Today’s orthodoxy is defined by elite high priests who possess secret gnostic knowledge.  Scripture is what the priests say it is.  Ordinary people have no access their secret data.  Opponents of orthodoxy are labeled heretics, and some are vilified as examples to those tempted to stray.  There are rites that involve the letting of blood, and these rituals must be repeated periodically to maintain continued salvation.  Mass demonstrations of faith by believers prove their devotion to a movement that promises a second coming of pre-pandemic life sometime in the distant future, even though exactly when and how that will happen is vague.  Occasionally, human sacrifice is required to appease the gods, but those chosen for sacrifice must not complain.  The lambs must accept their fates willingly.  There can be no dissent.  Heterodoxy is not permitted in a nation whose motto is “In Science We Trust.” 

This is not science; this is religion.  Despite the first amendment to our constitution, our country is being turned into a theocracy, worshiping at the altar of “scientism.”  Scientism is being used as a tool to advance a political agenda, not a scientific one.  

Science is a process that establishes our best understanding of truth by disproving all that is false.  Someone says, “I have an idea,” and other scientists set out to prove it false by experiment.  “If your idea is true,” the experimenters say, “then my experiment should work out this way; since it worked out that way instead, your idea must be false.”  Experiments never prove an idea true.  “Scientific truth” is a probability not a certainty.  It’s subject to revision when someone invents a better idea, shifting our understanding into a new paradigm. 

Skepticism is integral to the scientific process.  When doubt is not allowed, it may be many things, but it’s not science.

Categories
2021 COVID-19 Science Vaccine

Winning the War Against Therapeutic Nihilism

Dr. Peter McCullough spoke to the Association of American Physicians and Surgeons at their annual meeting on Saturday, October 2.  He gives a clear, easy to follow, scholarly perspective on the causes and treatments of COVID-19 and the safety and efficacy of COVID vaccines.  It’s a little more than an hour long, but I recommend you stop reading this blog and watch it by clicking here.   If you don’t have an hour to watch the video right now, here are my CliffsNotes version of Dr. McCullough’s talk, complete with video references.

There are serious safety concerns with COVID vaccines.  Lapses in usual safety standards plagued vaccine development and distribution (8:10).  Groups excluded from pre-authorization clinical trials are receiving vaccine (9:13), including pregnant women, women of childbearing age, COVID survivors, people with suspected COVID, and those with positive COVID serologies. 

The CDC and FDA have misled the public about vaccine safety.  They minimized vaccine related deaths (14:14), and they have not provided periodic safety reports.  Despite what is reported in the media, the FDA did not approve Pfizer-BioNTech COVID-19 Vaccine (22:10).  The CDC manipulated data to support the “Pandemic of the Unvaccinated” narrative (29:15).  Of Americans hospitalized patients with COVID during the delta wave, 23% have been vaccinated (32:20). The CDC and FDA have failed to emphasize that seniors suffer the most vaccine failures (30:20).  Instead, they are focused on authorizing vaccines for children, a group that has a greater risk of hospitalization for vaccine-induced myocarditis than for COVID-19 (18:16).  The CDC and FDA cannot be trusted to provide honest information about vaccines.  

The universal vaccination policy must change.  All vaccines have failed against the delta variant (26:45), and they have not stopped the spread of virus (23:57).  Vaccines are forcing viral mutations (34:05); as vaccination rates increase, natural viral diversity decreases.  Vaccines produce narrow, limited immunity (36:00), and vaccinating COVID survivors causes harm (49:19).  Vaccinated individuals are as likely to spread virus as unvaccinated individuals (37:07).  On the other hand, natural immunity is robust, complete, and durable (49:09).  Natural immunity is the only backstop to virus spread (50:00).  

Treatments, not vaccines, drive down COVID mortality (33:43).  COVID-19 is a complex disease, but early home therapy is effective (38:30).  Inadequate treatment is responsible for COVID-19 deaths (44:34).  Many seniors have been abandoned by their doctors (45:47), but A Guide to Home Treatment of COVID-19, made available free by the AAPS, fills gaps in management (46:39).  

People are losing human rights.  Basic freedoms are now dependent on vaccine status (50:24).  We need outrage over ineffective and unsafe vaccines (52:45), we need doctors to be doctors (54:35), and we need journalists who recognize that something is wrong (56:36), that there has been a suppression of treatment resulting in fear, suffering, loneliness, isolation, hospitalization, and death (56:50).

But my notes do not have the eloquence and power of Dr. McCullough’s own words.  Please, click here and listen to five minutes, then stop when you want.  If you can.

Categories
2021 Ethics Philosophy Science

A Physician’s Descent into the Abyss

Next to my wife and family, medicine is my life.  I go to work in a hospital almost every day, and while I’m there, I’m focused on the patients whose blood, fluids or tissues come to my attention.  I give them the very best I can, not perfectly, but humanly.  Many patients aren’t aware that pathologists exist, but if you’ve ever been on a Hero’s Journey involving cancer, you know who I am.  I was there at your jumping off point.  I’m the one who signed your biopsy report, giving you the information needed to face the monsters of your quest.  I’ve never personally experienced cancer, although both my wife and I have fathers who did, but I see cancer up close daily, and I frequently encounter those on the cancer journey.  

Here’s a short summary of the Hero’s Journey.  A hero candidate is called out of ordinary, mundane life to go on a quest. The candidate initially resists but is eventually drawn to the edge of the abyss and outfitted for the journey.  Descending into the darkness, the hero enters a fantastic, dream-like world where rules of ordinary life don’t apply.  Think Star Wars, Alice in Wonderland, or Odysseus in Hades.  Real dangers are encountered, and sadly, not all heroes survive.  But those that do come back to the ordinary world changed, and they share their wisdom with the generations.  Joseph Campbell’s masterful articulations of the Hero’s Journey demonstrate that this formula transcends cultures and epochs.  Cancer survivors know what I’m talking about because they’ve been on a Hero’s Journey.

Although I don’t feel much like a hero, COVID has sent me tumbling out of my ordinary world into an abyss.  My pre-pandemic world was based on trust.  Physicians are taught to think for themselves, but to doubt themselves at the same time.  More than anything else, our education and training teach us that we just don’t know enough.  There’s always someone smarter or intellectually more energetic, someone who dives deeper or stretches broader than we can ever hope to do.  Yet there’s something about this humiliating self-awareness that gives us the tools we need to help those in the ordinary world with their ordinary health problems.  We frequently consult trusted references, colleagues, and experts, and as we do, it slowly begins to make sense.  Experience gives us confidence, and that confidence is transferred to our patients.  Physicians become the handles patients hold onto when the earth drops beneath their lives.

The pandemic has changed all that.  Physicians feel compelled to take sides.  You either stand with most of your colleagues and friends, medical associations, and trusted institutions like the FDA and CDC, or you stand with what has made sense to you throughout your career.  The pandemic has made this an either-or proposition.  Like 1984, it’s a battle between your thoughts and the thought police; you either participate in the Two Minutes Hate enthusiastically, or you risk vaporization.

My trust in the CDC began to wane in May when, in contradiction to my education and training, the agency insisted on vaccination of COVID survivors.  My trust was further depleted when I realized testing would not be used to guide vaccination decisions despite years of established pre-pandemic practice.  Now, there is contradictory information published on CDC and FDA websites, and disregard for approval and authorization processes.  Yet even the act of pointing out these discrepancies separates you from the herd like a calf in a cutting horse competition.

I have decided to stand for truth with the confidence instilled by my education, training, and experience, no matter what. There’s a lot in that “no matter what”—isolation, ridicule, coercion.  But if you don’t have your thoughts, you don’t have your humanity.  Humans are not required to believe alike, but they are required to believe.  I am determined to crawl out of the abyss, humanity intact, back into the ordinary world, dragging as much trust with me as I can carry.

Maybe some of my colleagues will identify with what I’m saying.

Categories
2021 Ethics Science Vaccine

Deception

Misconceptions about COVID Vaccines are fueling vaccine mandates.  The CDC has contributed to these misconceptions by its recent statements and actions.  Trusted institutions and processes are now corrupted by a political agenda that has licensed vaccine mandates.  Next will be vaccine passports and social credit scores, resulting in the loss of human rights.

Last week, FDA published a new combined Vaccine Information Fact Sheet for Recipients and Caregivers About COMIRNATY (COVID-19 Vaccine, mRNA) and Pfizer-BioNTech COVID-19 Vaccine to Prevent Coronavirus disease 2019 (COVID-19).   This Fact Sheet explains the distinction between Pfizer-BioNTech COVID-19 vaccine and COMIRNATY (COVID-19 Vaccine, mRNA).  This document states that the two vaccines “can be used interchangeably,” but are “legally distinct” (see footnote 1).  COMIRNATY (COVID-19 Vaccine, mRNA) is an FDA-licensed vaccine for individuals 16 years old and older; Pfizer-BioNTech COVID-19 Vaccine is an authorized vaccine for individuals 12 years and older.  COMIRNATY inherits Pfizer-BioNTech’s EUAs; Pfizer-BioNTech is not grandfathered into CORMINATY’s license.

The new Fact Sheet also expands emergency use authorization for third shots (boosters) of both vaccines.  In doing so, the FDA followed the spirit, if not the letter, of its independent Advisory Committee Meeting on Vaccines and Related Biological Products Advisory Committee September 17, 2021 (watch following 7:42:00).  

On the other hand, the CDC’s information and guidance has been confusing and misleading.  On its website, the CDC ignores the legal distinction between the two vaccines so carefully parsed by the FDA, inaccurately lumping them under the label “Pfizer-BioNTech (COMIRNATY) COVID-19 Vaccine” and saying that the FDA approved this vaccine on August 23.  That’s not exactly true.  But the misinformation has taken root.  Even factcheckers are spreading the false claim that Pfizer-BioNTech and COMIRNATY vaccines are legally equivalent.  

Last week the CDC went further, recommending boosters for individuals not included in the FDA’s Emergency Use Authorization in contradiction to the CDC’s own Advisory Committee on Immunization Practices.  Dr. Rochelle Walensky, director of CDC, justified this action (watch following 27:57) by saying it was a “scientific close call,” (28:22) and that she would have voted in favor of the recommendations if she were part of the committee (28:36).  But she wasn’t part of the committee, and it wasn’t a close call.

Close calls are judgments made on the sports field, risk calculations during a game of chess, or complicated ethical determinations.  Close calls are decisions made with incomplete information, under the stress of time, that exceed our computation ability.  None of this describes science.  Science is a method that either disproves an idea or does not.  There are no “scientific close calls.”

The CDC overstepped its jurisdiction.  The FDA, not the CDC, issues emergency use authorizations. Yet now CDC guidance is at odds with FDA’s EUA, bypassing the safety afforded by this carefully thought-out process. 

There was a reluctance to embrace vaccine mandates until FDA licensed a vaccine.  On August 23, the FDA licensed a vaccine which is still not available.  Instead of giving us a licensed vaccine, the FDA gave us a license to mandate vaccines.  In August, the White House promised booster shots by September 20.  Last week boosters were made available under CDC guidance via a short-circuited process.  This is not science.  This is politics.

These are smart people who have studied logic and rhetoric at the finest colleges and universities in the land.  They should know better.  They do know better.  This is deliberate and bold deception.  Trusted instructions of science and medicine have been corrupted to further a political agenda.  Now that we’re out of the realm of science and in the world of politics, speculation runs wild.  My speculation is that someone wants to sell vaccines, and lots of them.  My speculation is that vaccine mandates will lead to vaccine passports and social credit scores which will eliminate our human rights.  No wonder there’s a crisis of trust in America.

Categories
2021 COVID-19 Vaccine

Long COVID

COVID-19, the disease of the pandemic, has two pathways.  In one pathway, viral infection directly causes the upper respiratory symptoms like runny nose, cough, fever, sore throat, and, in severe cases, pneumonia and respiratory failure.  The second pathways is associated with some of the more confounding symptoms of COVID-19 like loss of taste and smell, myocarditis, pericarditis, cardiac arrhythmias, migraines, cognitive deficits, Guillain–Barré syndrome, Bell’s Palsy, and blood clots.  These symptoms sometimes appear with infection, but often they emerge after the acute illness is over, and they may last a long time.  This is what is known as “Long COVID.”

Long COVID doesn’t happen to everyone infected by the virus.  It seems to affect women more than men, and the middle-aged more than the very young or the very old.  But for those affected, long COVID can be painful and debilitating.  

There are several ideas about what causes Long COVID.  One plausible idea is that the immune response mounted to fight SARS-CoV-2 attacks the body’s own cells.  In other words, Long COVID may be an autoimmune disease.  Viewing this phase of COVID-19 as an autoimmune disease forms the basis for the use of drugs known to tamp down the immune response as an early treatment or preventative for COVID-19.  These drugs may also help patients who are struggling with long COVID symptoms.

It’s intriguing that many vaccine complications overlap with long COVID symptoms.  Vaccine fact sheets contain warnings for myocarditis/pericarditis, blood clots, and Guillain-Barré Syndrome.  These are all immune-mediate processes—in other words, autoimmune disease from an immune system primed to attack your own body.  Vaccination is designed to mount an immune response to the spike protein, the tool the virus uses to pick the lock on the door to your body.  If Long COVID is an autoimmune response, it’s not surprising that vaccination may cause a similar response.

Another intriguing observation made by me and some of my colleagues, but one I’ve not found published, has to do with the timing of adverse effects of vaccination.  I want to be clear that adverse effects of vaccination seem to be rare.  Yet, complications occur.  The observation is that people who’ve had COVID-19 before taking a vaccine seem to have adverse effects of vaccine immediately if they have them at all.  Alternatively, people who have never had COVID-19 have adverse effects of vaccine weeks after vaccination if they have them at all.  It makes sense that people who’ve had COVID-19 have an immune system primed for an immediate response, while those that have never been infected need time before the effects are seen.

These observations bring up a couple of questions.  Can vaccination cause an autoimmune disease like Long COVID?  And if so, will treatments for Long COVID be helpful to those people?

There’s still so much we don’t know.

Categories
2021 COVID-19 Science Testing Vaccine

COVID Serology

The immune system is a big complex machine.  Medicine tries to simplify the machine to make it understandable and to manipulate it to our advantage.  That’s why we measure antibody levels in the blood.  The measurement of antibody levels in the blood is called serology.  Serology doesn’t measure the whole immune system, but we do it because it’s easy, and it gives us an idea of what’s going on.  

Your immune system is stimulated by molecular structures that are not native to you.  You could say that your immune system is xenophobic, reacting against foreigners. And your immune system has a long memory.  Once stimulated, these memories allow your immune system to mount a defense quickly should that foreigner ever be encountered again. For many infectious agents, including SARS-CoV-2, this means the formation of antibodies which can be measured in your blood.

When you are infected by the virus, your immune system is exposed to all the molecules that make up that virus.  Your immune system can respond to any of those molecules, including one special molecule: the spike protein.  We need to understand what makes spike protein so special.

Contact between the spike protein on the SARS-CoV-2 virus and a cell inside the nose is the first step in the infection of our bodies by these tiny invaders.  The spike protein is like a key that unlocks the vault, giving the virus access the interior of the cell.  Once inside, the virus hijacks the cell machinery, converting it into a virus manufacturing plant.  Thousands of copies of the virus are pumped out which infect neighboring cells, and the process repeats.

Antibodies to spike protein are special because they are neutralizing antibodies.  Neutralizing antibodies get between the viral key and the cellular portals, acting like putty gumming up the keyholes.  That’s why code for spike protein is the active ingredient in mRNA vaccines, and that’s why we should be able to measure vaccine response with spike protein antibodies.  Other parts of the immune system are activated too, but these work after the virus has entered the body.  At least that’s the theory.

How well does all this work?  Imperfectly.

While vaccination may reduce the risk of future infection, it does not prevent it.  Breakthrough infections occur.  Maybe that’s because neutralization only happens when antibody levels are high enough.  Or maybe neutralizing antibody levels fade within months of vaccination.  Or maybe the small alterations in spike proteins of variants make vaccine-induced neutralizing antibodies less effective.  Or maybe it’s a combination of all these ideas.  We really don’t know.

And there’s the point.  We really don’t know.  We certainly don’t know enough to make universal vaccination the sole objective of our pandemic response.  Vaccination is a tool that can be used to keep people alive, but it should not become the primary goal.  Other theories need to be investigated to identify our best hope for survival.

For example, here’s a theory that should be investigated.  Based on what we know about the immune response, natural immunity from COVID-19 should be more durable, more protective, and better for our communities than vaccine.  Why?  Natural immunity exposes the immune system to many different molecules, not just spike protein, making it more likely to sustain emergence of new variants.  More durable immunity generates longer lasting herd immunity, reducing the size of subsequent disease spikes.  At least that’s the theory.

How well does it work?  We don’t really know.  

Although other nations have found wisdom in this theory, the CDC has not permitted us to try it.  Instead, the CDC stubbornly holds on to the universal vaccination idea, even vaccinating COVID survivors regardless of their antibody levels.

So how do we get out of this?  We need data.  We need answers to questions like what antibody levels indicate protective immunity?  How long does natural immunity last?  Is vaccine-induced immunity as protective natural immunity against variants?  Can antibody levels be too high?  What are the optimal antibody levels?  

That’s why I’m excited about the Texas CARES Survey.  This study sponsored by the UT Health Science Center at Houston, with testing by my friends and colleagues at Clinical Pathology Laboratories (CPL), promises to give us large cohort retrospective data on durability and magnitude of antibody responses after disease and/or vaccination, with matching outcomes.  Although the study has met its initial enrollment goals, check back for results and more opportunities to participate.

Why has it taken so long to ask these questions?

Categories
2021 COVID-19 Ethics Science Vaccine

When We Lose Trust

There is a crisis of trust in America.  One manifestation is in healthcare.  For a century, the trust among Americans, their physicians, and institutions of public health built the most reliable healthcare system in history.  Today that trust is being undermined, and the entire system is in danger of collapse.  If we do not restore trust, we will suffer the reversal of a century’s gains in medicine. 

The Youngest Science, a collection of essays by Dr. Lewis Thomas, traces medicine’s journey from pre-twentieth century practices into the evidence-based practices of today.  Before this transformation, medicine was an unreliable mixture of traditional treatments like blood-letting and fanciful concoctions like snake oil tonic.  Transparency, empirical evidence, and patient collaboration were absent.  

Although there were many well intentioned physicians before the twentieth century, greedy hucksters and evil-doers thrived in this environment.  Quacks with phony credentials wagoned into town hawking the one-and-only genuine medicinal potion that promised to cure whatever ailed you, often accompanied by craftily staged demonstrations.  After selling as many worthless “cures” as possible, these predators escaped at night, leaving townsfolk poorer but in no better health.   People naturally feared being duped again.  Medicine could not progress in this environment.

In the twentieth century, trust changed all this.  Beginning in 1906 with the Pure Food and Drug Act, the federal government developed institutions like the FDA, CDC and NIH to assure the safety and effectiveness of drugs and treatments.  State governments licensed physicians and established standards of medical practice.  Physicians organized, creating boards to prevent frauds from entering their ranks and abusing the trust of their profession.  By the end of the last century, healthcare providers were among the most trusted professions in the nation.  So much so that people were willing share intimate personal details with a stranger, as long as that stranger was a doctor or a nurse. 

Now we see an erosion in the trust at the foundation of the youngest science.  When trusted institutions like the CDC and FDA give incomplete or misleading statements, physicians lose a resource for reliable information.  This quickly translates to a loss of the trust that bonds patients and physicians.  As employers and political leaders displace physicians by claiming to be health experts, people are unsure who to believe.  We’re back in the nineteenth century again.

It didn’t have to be this way.  We could have leveraged medicine’s abundance of trust to lead us to recovery.   Our trusted institutions could have given physicians the tools needed to make meaningful risk-benefit calculations for patients.  But this would have required the acknowledgement that natural immunity is at least as good as vaccination in some COVID survivors, that vaccination is harmful to some individuals, and that vaccination does not prevent the spread of disease.  We could have determined which groups receive the greatest benefit from vaccination, and which groups are most likely to suffer adverse effects.  We could have guidance on measurable markers of immunity—what are the minimum protective antibody concentrations, and what levels are toxic—so that those at greatest risk of death from COVID-19 can determine whether they will benefit from vaccination or booster.  We could have real data on adverse effects of vaccines by age and health status, and we could have balancing data on risk of death by SARS-CoV-2 infections.  We are 18 months into the pandemic; we should have this information by now.  Instead, our public health institutions have adopted an incredulously monolithic policy, saying universal vaccination is our only way out, even though we know this policy violates the oath of my profession: Do no harm.

Our trusted health institutions, like our trusted political institutions, have failed to communicate a clear, achievable objective for the pandemic.  They have failed to demonstrate a connection between their policies and the achievement of this goal.  As a result, we’ve lost trust.  This crisis of trust has created a crisis of healthcare.

We must restore trust, together.  The health of our nation is at stake.

Categories
2021 Philosophy Science

Is It Science?

How do you carve a statue of an elephant?  Start with a block of stone and chip away everything that is not elephant.  Science is like that.  The elephant is truth; science is the chipping away.  Scientists are the carvers, chiseling different parts of the stone block at once, testing and repeating each other’s findings, remodeling as new evidence emerges, and accepting the image that finally appears.  Science is more verb than noun.  It’s not the science; it’s just science.

You can’t predict what science will reveal hidden in the stone block.  Even after the block is partially carved, you can’t be certain about important details that are still hidden from view.  Science doesn’t reveal truth until scientists have finished their work, and that work cannot be rushed.

True science is open source.  It invites questions, dissent, and transparency.  True science is not condescending.  True science can be understood by people with common intelligence.  More than anything, true science is honest.  When you identify misstatements, half-truths, or “believe me because I know better than you,” it doesn’t necessarily mean someone is trying to rob you, but it does necessarily mean you are not dealing with science. 

And this is the point.  Today’s intemperate rhetoric claiming to be science isn’t science at all.

I don’t have all the answers, but I recognize the absence of science in statements of leaders who say, “This is a pandemic of the unvaccinated.”  The wisdom of universal vaccination, the benefits of vaccine mandates, the rejection of natural immunity have not been established scientifically.  The use of ivermectin and hydroxychloroquine as prophylactics and early treatments have not been disproven scientifically.  Yet there is an unrestrained rush to incorporate these ideas into the dogma of previously unimpeachable institutions and into our public health policies.  It makes me sad.  It makes me fearful for our future.