Covid, the Politicization of Science, and More Questions about the Pfizer Vaccine Approval
It’s alarming and disheartening to see that the effort to combat Covid is becoming more and more politicized. It’s not just the elements that will are inherently political, since they involve government decisions and allocations of resources, like whether to restrict international air travel, mandate quarantines, provide support to households and businesses for lost wages and revenues, and decide who gets first dibs on scarce supplies. It’s that the elements of the debate that the great unwashed public would really like to be in the hands of unbiased trustworthy experts are now as much subject to politics and fashion as whether Covid relief will be means-tested or not.
One of the side effects is Joe Biden making nonsensical statement like “Trust the science.” Science with respect to medicine is regularly a medieval art. Either practically or ethically, we can’t run large scale studies on representative populations. We’re often stuck with observation, experimental-level studies, and correlations as opposed to clear-cut causality. And too often, the people making those studies have reason to over-hype the results, even if it’s just to get their research noticed.
The situation is made worse with the high level of corruption in our society, starting with private rentierism in hospitals and emergency services. Experts have complained about corruption in scientific research for decades, to the degree that a lot of the public has become aware of it. Agnotology to muddy the mounting evidence against smoking, and later, against carbon emissions. Vioxx. Oxycontin. Overdiagnosis of behavioral disorders in children, accompanied by unprecedented administration of medications. In medicine, this is the direct result of drug companies and health care providers being more and more driven by commercial rather than patient interests.
Profit pressures have also degraded the doctor-patient relationship. More and more MDs work as employees rather than in their old configuration of independent small businessmen, and their corporate masters regularly not only dictate how many patients to see in the day, but also a lot of their treatment protocols. Allegedly, the latter is driven by the need to get more doctors to adhere to the standards of evidence-based medicine. Some practitioners retort that quite a few patients have problems that don’t fall tidily into adequately researched boxes, and clinicians need to be able to make judgement calls.
None of this is new, but it’s important to remember these issues as the debate over Covid policy continues. The US has backed itself into the corner of having to hope for a medical magic bullet due to our inability to mobilize a society-wide response to Covid. And it’s not just authoritarian China that has done better. Thailand, which has Bangkok, literally the most visited city in the world as its commercial center, has a population of 75 million and has had 60 Covid deaths. Yes that means 60 in total. Alabama, with 4.9 million people, had 56 Covid deaths yesterday.
Even parts of the West that had initial successes, as we know all too well, have backslid spectacularly, loosening up too much in the late summer and fall. And now that the disease is well entrenched, it seems just too hard to have a hard lockdown for five to six weeks, pay people and business enough to get through a deep freeze, and put in place post lockdown measures with teeth, like serious fines for breaking quarantine (and support during quarantines, like stipends and delivery of food and other supplies). The purpose of this post is not to debate what that program might look like, but to posit that there is one, and that stop-and-go leaky lockdowns are likely to be as costly in human and financial terms in the long term.
So instead, the US is putting all its eggs in the Covid vaccine basket. That is coming at the expense of pursuing other approaches in parallel to reduce the health cost and societal damage of the disease. As we said early on, if we didn’t get lucky as we did with SARS and have it mutate into a less virulent form, we would need a combination of treatments to reduce disease severity, morbidity and mortality, and vaccines. There was no reason not to pursue both routes aggressively, in parallel. Recall that the fight against AIDS involved both trying to come up with a vaccine as well as experimenting with many drugs and later drug cocktails.
But as we are already seeing, due to the fixation on a vaccine, and Operation Warp Speed adopting a bizarre “first past the post” approach and letting Pfizer enjoy a first mover advantage (rather than trying to the extent possible to compare candidates against each other and see which might be the most suitable for various patient and delivery situations), of having anyone who questions the unprecedented rushed development and approval of vaccines being treated as an anti-science crank and a threat to public safety. What about “precautionary principle” don’t you understand?
Our IM Doc had to post his reading of the Pfizer article and editorial in the New England Journal of Medicine anonymously out of fear of losing his job. We also received e-mails from doctors supporting IM Doc’s post, including one that argued he’d skipped over some concerns about the Pfizer vaccine. I felt I could share this one from Dr. Harvey Risch, Professor of Epidemiology at Yale School of Medicine, since it restates positions he has taken publicly:
I read your essay from the internist critical of the vaccine data and policies that have come out so far. I strongly share his/her concerns. I have been working in Covid early outpatient treatment since March of this year and you are probably aware of the massive propaganda war being conducted against outpatient treatment by pharma companies, vaccine companies, FDA, NIH, WHO, as well as the numerous academic pontificators who have never treated even one Covid outpatient.
I am involved in two private email groups comprised largely of MDs discussing evidence for Covid early outpatient treatment. We have published a number of papers (e.g., https://www.amjmed.com/article/S0002-9343(20)30673-2/fulltext) as well as op-eds such as the following:
Because of the mainstream media censorship of our position that early outpatient treatment is safe, successful, inexpensive and would largely solve the pandemic without necessity of or even better than vaccines, most of our messaging has appeared on the political right. However, we span the political spectrum as can be seen by a recent article here:
We are all actively working as best we can to bring clinical relief to patients. Thanks very much, and thanks for publishing IM Doc’s outstanding critical analysis.
My best wishes–