Why Would Any Black American Trust These New Vaccines?

The full, ironic title of this blog post is actually “Why would any Black American trust these new vaccines? A white doctor’s perspective (because, you know, that’s exactly what we need more of),” but it was too long to fit in the title heading.

As a white, male doctor, I am not the best person to write this blog post. Thankfully I am not the only person writing and talking about this, and am in fact a late comer both to the issue of higher rates of vaccine skepticism within medically marginalized communities and to the larger issues of racial health equity and healthcare justice in general. Much of the work that has already been done in this area comes directly from Black physicians, scientists, healthcare workers, and community leaders who are concerned about the disproportional impact the COVID-19 pandemic has had on people of color, and have been working hard on behalf of their communities to verify that the vaccines are trustworthy and effective, and to ensure equal access to this lifesaving intervention.

I believe those voices are far worthier of your time than this post, whether you yourself are a member of a medically marginalized group trying to decide about the new vaccines or, like me, someone who just wants to gain a deeper understanding of the ways that American medicine’s history of racial discrimination and research exploitation have contributed to ongoing healthcare disparities and earned mistrust. That’s why I’ve flipped the usual structure for this post and have placed additional resources and reading as the first proper section, instead of tacking them on at the end or dispersing them throughout the essay. Many of the resources I’ve included come directly from my Black peers in medicine, or our colleagues in research or community health.

So I write about this topic today not because I believe my perspective is the most important one or because I believe I have something particularly unique to add to the conversation, but rather because I believe this issue is so important that we should all be talking about it. Further, I am writing because a certain number of African American men and women have already entrusted me, as their primary care doctor, with the the sacred responsibility of helping them navigate these issues as they make decisions about whether or not to trust the vaccines, and because a good portion of my time over the past few weeks has been spent doing that work. And finally, I am writing because the vast majority of those medical research atrocities that laid the groundwork for the dilemma many Black Americans face today were committed by people within a group I belong to: white, male, American doctors. And even though I claim no kinship with their ilk, and believe that in breaking their sacred oath and committing grievous harm against their fellow man they have forfeited the title of “Physician,” nevertheless I have benefited in various ways from those crimes, and believe that a responsibility rests specifically with white doctors to do whatever we can to bring that history to light and mitigate its consequences. We should not strive to dominate the conversation, as we have so often done; but neither can we stay silent and remain complicit in that exploitation.

Contents:
COVID-19 Vaccine Resources from Black Medical Experts
The Problem: A History of Racist Medical Research Abuse
The Other Problem: The Unequal Burden of COVID-19
My Conversations with Black Patients


COVID-19 Vaccine Resources from Black Medical Experts

If like me you find that you only have a limited amount of time to read today, I would recommend the following resources; you can always come back to my blog post later.
In other words, start here.

Black Coalition Against COVID-19

BCAC19 is a DC area coalition of Black doctors, scientists, healthcare workers, community leaders, academics, and political voices working together to stop COVID-19 misinformation and rebuilt trust in medicine, in order to help Black communities fight the pandemic.

On their website they host public health resources, a COVID-19 FAQ, and town hall videos with medical and community leaders discussing issues around the COVID-19 vaccines.

“Love Letter to Black America”

The Black Coalition Against COVID-19 has also produced this short but important video touching on the importance of trust and accountability in every step of the vaccine creation and rollout process.

Why distrust for COVID-19 vaccines may be higher in African American Communities”

This video and article focus on Jeff Fard, founder of the Brother Jeff Cultural Center in Denver, and his work on combatting the health consequences of COVID-19 on his community. It then branches out to look at what Black-led medical institutions and organizations are doing to support communities of color across the country during the pandemic.

The Black scientist who helped develop Moderna’s COVID-19 vaccine just got her first shot

One of the many excellent articles about Dr. Kizzmekia Corbett, PhD, Virologist and one of the team leads who helped develope Moderna’s mRNA vaccine (the one I and so many of my colleagues and patients have already received).

Personal Essay by Dr. Lisa Fitzpatrick, MD, MPH

A featured essay in Business Insider magazine, written by Infectious Disease expert Dr. Lisa Fitzpatrick. “I’m a doctor who volunteered to get one of the first coronavirus shots. Here’s why I got involved, and what the side effects have been like.”

Waco COVID-19 Vaccine Townhall, 1-21-2021

Local Resource: This is a Waco COVID-19 Vaccine town hall led by African American community leaders, from just a couple of weeks ago. It features Dr. Terri Woods-Campbell, a former teacher from my days in medical residency, and one of several Black, female Physicians who trained me in surgical skills over the years.

Race and the Roots of Vaccine Skepticism

This is a short NPR interview with one of my favorite historians, Harriet Washington, author of Medical Apartheid: The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present. She discusses the Tuskegee Syphilis Study, but also the much broader history of medical research abuse and exploitation of Black Americans of which the Tuskegee study was only the most widely known and notorious example.

The Slave Who Helped Boston Battle Smallpox

This one is more academic but offers such an important perspective on the vaccines. It shares an account I first discovered in the pages of Medical Apartheid; the story of an African man known only by his slave name, Onesimus, and how his knowledge of traditional African healing practices and the techniques of variolation saved hundreds of lives from Smallpox and pointed the way toward the future of vaccination science.


The Problem: A History of Racist Medical Research Abuse

I’ll start with a personal story (so bear with me). During my first clinical rotation during 3rd year of medical school, I worked with an upper level resident who despised me. And she had good reasons. I was really struggling academically at the time and my medical knowledge was far behind my peers. Just as importantly, I was a rotation behind them in 3rd year clinicals; it was my 1st rotation, but their 2nd, a lifetime in terms of clinical experience and ability to contribute to a medical team. All of this together meant I was a weak medical student (in medical education we inexplicably still use words like “weak” and “strong” to describe people who struggle with different aspects of the incredible burden of practicing medicine) and, in all honesty, a big drain on her teaching time and resources.

One day during lunch, the program director was lecturing on the history of Gynecology and the techniques and instruments invented by Dr. J. Marion Sims, the “Father of Modern Gynecology,” in Montgomery Alabama in the early 1800’s. The program director posed this question, seemingly rhetorical: “Historically, medical researchers have not always had access to enough volunteers for new techniques and medicines, so who have they used when volunteers weren’t available?” I was a weak med student but I at least had a liberal arts education and knew a little about history, sociology, and moral philosophy, so I answered; “minorities and the poor.” My upper level resident clearly interpreting this as either an off-color joke or even an endorsement of such practices, and generously wanting to save me from immediate expulsion from medical school, shot out her hands in a gesture meant to quell the coming storm and exclaimed to the whole table, “He’s joking. You’re joking, right? Tell them you’re just joking”

But I wasn’t joking, and said so; those groups were exactly who had been used for medical research when the experiments were too dangerous or degrading to recruit volunteers, and it was pretty clear that that was exactly where the program director was headed in that talk. We spent the rest of the lecture learning about the abuse and violent exploitation of poor, Black slave women that had enabled Dr. Sims to perfect his techniques before using them on the patients actually meant to benefit from his research; wealthy whites. These techniques, practiced on slaves without anesthesia and often resulting in infection or other severe complications, eventually made his name famous and led to his becoming the president of the American Medical Association. Only recently has Dr. Sims lost some of the celebration he attained in life because of this history. (The brief slideshow below shows his statue being removed from New York’s Central Park in 2018; you can read about it on NPR from the link provided)

‘Father Of Gynecology,’ Who Experimented On Slaves, No Longer On Pedestal In NYC

But before I run the risk of anyone thinking the above is a story of my wokeness as a medical student (exploitation of allyship, anyone?), I was anything but. I had got the answer right that day (probably for the first and last time during that 2 month rotation) more because I was good at guessing what a lecture was about from the intro than any actual insight into issues of race and justice. I had learned about the Tuskegee Syphilis Study in college, I learned about J. Marion Sims that day in med school; and later during residency I was confronted constantly with the realities of racial healthcare disparities today. And that was it. I was aware of three ‘situations’ out of a 400 year history of abuse, violence, neglect, and exploitation. And for several years, though I grew slowly in this area and fought for healthcare justice 80+ hours a week, I remained essentially ignorant to the actual scope of American Medicine’s racist history (and, you know, racist present).

And if I’m being perfectly transparent and honest, I was at times really frustrated by how my African American patients sometimes seemed to be slower to trust me as their doctor, or to be more suspicious of treatments I recommended, than a lot of white patients. Like many people, I no doubt would have responded to the recent revelation that only 25% of Black Americans planned to get vaccinated against COVID-19 with knowing sagacity; ‘for some reason, Black patients are just more suspicious of modern Medicine. Hmm, oh well… I guess it will always be a mystery.

Then in 2020 a chance recommendation led me to download an audiobook (and then later purchase a hardcopy and an E-Edition) of Harriet Washington’s Medical Apartheid. A keen historian and a lover of science and medicine, Ms. Washington started with J. Marion Sims like we did that day in medical school; but then instead of jumping ahead a hundred years to Tuskegee or Henrietta Lacks, carefully traces a thorough but not exhaustive (as she herself states, that undertaking would take a lifetime and would fill volumes) history of clinical and especially research abuse towards Black Americans, beginning with the medical abuses towards slaves that were so common on the plantation and continuing through emancipation and reconstruction, Jim Crow, the Civil Rights movement, into the modern era and the exportation of medical research abuse to Africa where researchers can more easily get around ethics regulations, and finally concludes in the 1990’s and early 2000’s (it was published in 2006) with exploitative research in topics from drug dependence to human reproduction to criminality, all of which continue to pick and choose data to portray ethnic minorities, and especially those of African descent, as less developed, more aggressive, and in many ways less human (though less overtly than the “research” of the 1700’s and 1800’s) than the “normal;” that is to say, white people.

I’ve been thinking of the best way to distill this incredible, earth shattering, 512 page work into a single section of a blog post, and I’m at a loss. We could choose any of the hundreds of examples she gives in the book as reasons why Black Americans might be slower to trust American medicine than their white neighbors.

One that stood out to me was the section “Racism by Numbers” in Chapter 6 when she discusses the US Census of 1840 which showed significantly higher rates of mental illness and disease in free Blacks compared to those still in Slavery; proof, according to Southern plantation owners and their political allies, that freedom was unhealthy for Blacks, that they were too mentally feeble to handle making their own daily life choices. That scientific data was a huge blow to the abolitionist movement against slavery… Until it was utterly debunked as false and based on horrible methodology and underlying racism, by an African American Physician, Dr. James McCune Smith (the first Black American to earn a medical degree, though he had to go to medical school in Scotland to be allowed to do it) and a white Physician and statistician, Dr. Edward Jarvis. I mentioned listening to Medical Apartheid on audiobook; I was listening to this section during a run, and as someone who spends a considerable amount of my time fighting misinformation, was literally whooping and fist pumping throughout the story of how Dr. McCune Smith and Dr. Jarvis systematically dismantled the failed assumptions and overt racist methods of census takers, who had relied on the reports of plantation owners and slavers to collect data on the health of their slaves, and in many Northern cities reported several times more free “negro lunatics and idiots” (medical vernacular of the time) than the actual total free Black population of those towns. If someone had seen me on my run, they would think I was listening to my favorite team winning a big match; and in a way I was, though in this case even the thorough work of these two brilliant scientists was not enough to erase the damage done by the 1840 census, and chattel slavery continued for another 25 years and only ended with the conclusion of the Civil War.

Or we could look at the display of Black bodies- both living and dead- for popular curiosity and scientific study throughout the 1700’s and 1800’s that she outlines in Chapter 3: Circus Africanus and Chapter 5: The Restless Dead. Or radiation experiments conducted without informed consent on Black Americans throughout the early to mid 1900’s, which she outlines in Chapter 9: Nuclear Winter. Or at Chapter 11: The Children’s Crusade, where she reviews the research conducted throughout the 1990’s attempting to link criminality to genetics and hence to Blackness; research conducted on children and under extremely questionable scientific methodology that strived to prove Black Americans were genetically predisposed towards all manner of violence and anti-social behavior.

But instead of a doomed effort to recreate the progression of Ms. Washington’s meticulously researched review of medical research abuse of Black Americans from the dedication to the epilogue, I want to strongly encourage you to buy a copy and read it or listen to it. Below I share the section and chapter titles, but you have to read it for yourself to discover how richly and clearly she explains the long, relentless violence of medical research towards our Black neighbors, friends, and loved ones.


Medical Apartheid: The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present

Contents

Introduction: The American Janus of Medicine and Race

Part 1: A Troubling Tradition
Chapter 1 Southern Discomfort: Medical Exploitation on the Plantation
Chapter 2 Profitable Wonders: Antebellum Medical Experimentation with Slaves and Freedmen
Chapter 3 Circus Africanus: the Popular Display of Black Bodies
Chapter 4 The Surgical Theater: Black bodies in the Antebellum Clinic
Chapter 5 The Restless Dead: Anatomical Dissection and Display
Chapter 6 Diagnosis: Freedom: The Civil War, Emancipation, and Fin de Siècle Medical Research
Chapter 7 “A Notoriously Syphilis-Soaked Race”: What Really Happened at Tuskegee?

Part 2: The Usual Subjects
Chapter 8 The Black Stork: The Eugenic Control of African American Reproduction
Chapter 9 Nuclear Winter: Radiation Experiments on African Americans
Chapter 10 Caged Subjects: Research on Black Prisoners
Chapter 11 The Children’s Crusade: Research Targets Young African Americans

Part 3: Race, Technology, and Medicine
Chapter 12 Genetic Perdition: the Rise of Molecular Bias
Chapter 13 Infection and Inequity: Illness as Crime
Chapter 14 The Machine Age: African American Martyrs to Surgical Technology
Chapter 15 Aberrant Wars: American Bioterrorism Targets Blacks

Epilogue: Medical Research with Blacks Today.


Though full agreement might be impossible until you have read the book for yourself, it is at least clear to me that the history of medicine in the United States, and particularly of medical research, is sufficient reason for Black Americans to have increased wariness of anything in medicine that is seen as experimental or unproven. But a natural objection presents itself; “But TJ, most Black Americans haven’t read Harriet Washington’s Medical Apartheid, so that history can’t possibly be the cause of their unease or suspicion.

Reasonable enough on the surface, this objection fails to recognize the fact that Black Americans, generation after generation, have experienced medical apartheid, whether they have read Ms. Washington’s seminal work or not. Most American’s have at least heard of the Tuskegee Syphilis Study*, and in a hundred news articles talking about African American hesitancy towards the COVID-19 vaccines you will read phrases like “the legacy of Tuskegee” or “almost 50 years since the Tuskegee study.”

This was from today.

But for Black Americans that notorious series of events is not a one-off episode or anomaly in an otherwise untarnished history of medical altruism and benevolence, but part of a shared cultural narrative of the potential dangers of trusting too readily in scientists, researchers, and lamentably, doctors. Harriet Washington says it better than I can:

It is a mistake to attribute African Americans’ medical reluctance to simple fear generated by the Tuskegee Syphilis Study, because this study is not an aberration that single-handedly transformed African American perceptions of the health-care system. The study is part of a pattern of experimental abuse, and many African Americans understand it as such, because a rich oral tradition has sustained remembrances of pain, abuse, and humiliation at the hands of physicians. We should remember that, as Vanessa Northington Gamble, M.D., director of Tuskegee University’s National Center for Bioethics in Research and Health Care, averred, “many African Americans fear and distrust Western medicine who have never heard of Tuskegee.”

So yes, that ‘25%’ statistic is incredibly disheartening, but it’s also understandable once we know something of the historical context of the relationship between modern medicine and people of color. And while these new vaccines are not experimental and fears of being a “guinea pig” by taking the vaccine really are unwarranted for anyone, those concerns are common among many people of all racial and ethnic backgrounds in our current climate of mistrust and disinformation; and it is not a mystery that those fears might be stronger among Black Americans, with the weight of 400 years of medical and research abuse behind them.


*A note on Tuskegee
I would be remiss if I didn’t at least touch on a the basics of the Tuskegee Syphilis study, though Medical Apartheid does a much better job than I can. This was a study that was run by the US Public Health Service in Macon County, Alabama from 1932 to 1972. The full title of the study was “The Tuskegee Study of Untreated Syphilis in the Negro Male“, and as awful as that sounds it’s probably even worse than what you’ve heard. The public health service initially recruited 600 Black men from among poor sharecroppers in an impoverished county in Alabama; they chose 400 with evidence of latent syphilis and 200 without syphilis as a control group. There were some treatments for syphilis available in 1932 when the study began, but none of them were particularly effective; nevertheless, not even these were offered to the men in the study at any point, even though they were given dummy pills and told they were being cured. The intention was never to cure them, but to carefully observe and document the progression of the disease from its early stages all the way until death, and then conduct post-mortem examinations to see which organs and body systems had been deranged or destroyed by the unchecked bacteria. Of course, this was not only done without consent, but through active and ongoing deception of those involved in the study.

It gets worse. Alexander Fleming discovered Penicillin in 1928, just 4 years before the Tuskegee experiment began; but it wasn’t used clinically until the 1930’s and early 1940’s. It became standard of care for all manner of bacterial infections by the mid 1940’s, and by 1947- 15 years into the 40 year Tuskegee study- was both widely available and a known cure for syphilis. Not a treatment; a cure. The researchers and even the administrators over the Public Health Service met to discuss whether the research project should end and all of the participants be offered Penicillin. Appallingly, they decided that, no, the study would continue. Their reasoning? Now that a cure for the disease had been discovered, this was the only chance to find out what the long-term affects would be if it was left untreated. Please… Stop and process that reasoning for a moment.

The study continued for another 25 years. Participants became wise to the fact that syphilis was now being treated elsewhere with a simple injection instead of countless check-up visits, seemingly ineffective medications, and steady progression of the disease. Many of the men sought treatment elsewhere at other Public Health Service clinics, one of the few places they could receive affordable care; only to find that their names and information had been sent ahead of them. Those in charge of the study had sent a list throughout the Public Health Service network: these men were part of a PHS study; they should not receive treatment for syphilis outside of the study. I hope I do not have to pause here and explain how antithetical this study was to every ethical principle in medicine, every moral imperative towards our fellow human beings. Participants were tricked and lied to, denied effective, curative medication, and then when they discovered the grift and sought care elsewhere they found that steps had already been taken to block their treatment there as well. Some did manage to get treated, by seeking care in other clinics or providing assumed names in order to get the penicillin; but most had already suffered the devastating neurologic effects of late syphilis… Just as the study designers had intended. The study finally ended in 1972 when news of it was leaked by the media (you know, that mainstream media you just can’t trust…); it was popular outrage that finally shut it down, not any moral or ethical consideration by the Public Health Service or the individual researchers, scientists, or doctors that were involved.

That, in a nutshell, is the history of the Tuskegee Syphilis Study. Medical Apartheid’s seventh chapter, “A Notoriously Syphilis-Soaked Race”: What really happened at Tuskegee does it more justice, and by itself is worth the price of the book. That history is more or less known, especially among Black Americans; and even were it just that, wouldn’t it be enough?


The Other Problem: The Unequal Burden of COVID-19

A recent viral video of Dr. Simone Gold, one of the founders of the COVID-19 disinformation group “America’s Frontline Doctors,” featured a long segment where she accuses the CDC of overt racism for stating explicitly that they both aim to make COVID-19 vaccines widely available in communities of color, and for listing strategies to increase acceptance rates and combat vaccine hesitancy in those communities, including recruiting celebrities and other influential people to encourage vaccination.

On the surface, her claims actually sound fairly reasonable; given the history above, any efforts for medical treatments to target specific racial demographics, and especially a historically (and concurrently) oppressed group, has to be carefully scrutinized. Erroneously believing that vaccines are poison, and that these COVID-19 vaccines are “experimental”, Dr. Gold (had she read Medical Apartheid) would make the claim that the CDC’s efforts today are just the latest in the long sequence of medical research efforts that, intentionally or not, resulted in the exploitation, humiliation, and harm of Black Americans.

And she would be wrong.

The key difference, as Harriet Washington herself points out over and over again throughout her work, is that these efforts by the CDC are therapeutic, not experimental. Dr. Gold’s claims about the experimental nature of the vaccines is demonstrably incorrect (see my most recent blog post), as she herself is well aware. Calling them “experimental” or unproven, or referring to vaccine recipients as ‘guinea pigs’, is merely a scare tactic; and one that could be particularly effective when targeted at groups who already have legitimate grievances against American medical research. It goes without saying, but Dr. Gold is also wrong about the vaccines being dangerous; the safety trials were extensive and rigorous, and the protection offered by the vaccines against a horribly deadly virus is excellent. Rather than being a malevolent attempt to test the vaccines on Black people to make sure they are safe for whites, as was the case with Dr. J. Marion Sims’ surgical procedures in the 1800’s and the radiation trials in the 1990’s, this is an altruistic attempt to ensure that Black Americans have equal access to a treatment that has already been proven safe and effective. Finally, in contrast to those experiments, the efforts to address vaccine hesitancy and combat misinformation within Black communities are being done with not only buy-in, but active leadership by Black physicians, scientists, researchers, and public health experts. This is certainly the case on the national level, where organizations like BCAC19 are working with government and healthcare organizations across the country. But it is also being done on the local level in many places. My own clinic has a list of resources similar to the one in this blog that I often provide to Black patients in the context of a conversation about the COVID-19 vaccines and America’s history of racist medical research abuse. It was created specifically at the behest and encouragement of one of our African American physicians, and vetted by a work group dedicated to race health equity.

Treatment, not experimentation.
Beneficence, not malevolence.

Black leadership, not subjugation.

The effort to help Black Americans get vaccinated against COVID-19 is the polar opposite of the very real history of medical research exploitation Dr. Gold wishes to link it to.

But why is it necessary at all? Because despite what Dr. Gold implies in her video by factoring out the health outcomes associated with our long history of racial discrimination, healthcare inequality is a very real factor in America today. And if you need proof, look no further than the data around COVID-19.

Black and Hispanic Americans are far more likely to die of COVID-19 than their white counterparts, and the gap only widens when you factor for age. This is because non-white Americans have consistently faced discrimination and unequal access in healthcare, both individually but especially systemically, and this has resulted in a greater burden of disease for many illnesses and conditions that are independent risk factors for a bad outcome from COVID-19 infection.

Compared to whites, Black Americans are twice as likely to be uninsured. They are more likely to die from cancer despite many of those cancers occurring at higher rates in other groups. The rate of infant mortality is 11 for every 1,000 live births, compared to the national average of 5.8 for every 1,000 live births, and Black mothers are 2-3 times more likely to die from pregnancy-related complications than white mothers. Black men have the lowest rates of survival 5-years after receiving a diagnosis of heart failure. Black men and women are less likely to receive cancer screening and preventative health services. And Black Americans are less likely to have a primary care doctor or clinical home and get their care piecemeal in the emergency room setting, and not surprisingly, consistently report higher levels of distrust in doctors and healthcare.

Dr. Gold and others wish to ignore these factors, to make it seem that there is no need for efforts to ensure the vaccine gets to Black communities. After all, if such efforts are not desperately necessary, they must just be inherently racist. It’s a clever enough ploy, but look at all the history that has to be white-washed in order to eliminate the unequal burden of COVID-19 on Black Americans.

Dr. Gold and others say the difference in death rates between races decreases if you adjust for socioeconomic status and poverty. Manipulating the statistics in this way erases 246 years of chattel slavery, 89 years of Jim Crow, and 67 years of unequal wages, discriminatory hiring practices, and unequal higher education access.

Dr. Gold and others say the difference in death rates between races decreases if you adjust for conditions that increase transmission; crowded neighborhoods, multi-family buildings, use of public transportation, and cramped living conditions. Manipulating the statistics in this way erases 247 years of Black American not being allowed to own property, 67 years of over legal housing discrimination, 35 years of redlining, and 53 years of ongoing housing discrimination even after the Fair Housing Act.

Dr. Gold and others say the difference in death rates between races decreases if you adjust for chronic medical conditions. Manipulating the statistics in this way erases the over 400 years of medical exploitation and ongoing healthcare disparities we’ve already discussed.

We could go on. It’s well and good to say that, all things being equal, the COVID-19 virus doesn’t seem to have any race-based predisposition to harm people of color more than whites. But all things are not equal. Our longterm investment in the destruction of Black Americans’ health is now paying compound dividends, as our seemingly impenetrable barriers to access and long neglect of Black healthcare needs places Black communities in a position of heightened vulnerability to devastation by the COVID-19 pandemic, and our sinister history of medical research abuse rightfully increases the wariness many already feel about the new vaccines, our best protection against it. Those who deliberately spread COVID-19 vaccine disinformation are banking on this dynamic increasing acceptance of their false and fantastic claims, and there is something particularly evil about using the lasting wounds of centuries of medical victimization, neglect, and exploitation of Black Americans to further victimize them by damaging their access (medical misinformation is a healthcare access issue) to the best life-saving interventions we currently have available.


My Conversations with Black Patients

So this is the double-edged sword facing our Black friends, neighbors, and loved ones, and my Black patients; on the one side, ongoing disparities that put them at greater risk from the virus, and on the other a history that legitimately causes mistrust in the best tools we have to fight it. Each and every day in my clinic I am talking with Black patients who are aware of Tuskegee, who are aware of Henrietta Lacks, who are aware that these cases are not isolated incidents, and who are seeing all of the same anti-vaccine propaganda and fear-mongering that you and I are on social media.

Many are not at all fooled. They have been navigating this dynamic their entire lives and are used to making these sorts of difficult decisions. They are well aware of the threat COVID-19 poses to themselves and their loved ones. Many of my Black patients at highest risk- healthcare workers, those who are older or have medical complications- have already been vaccinated through our clinic. We are working daily (a physician friend of mine is working literally day and night) to create vaccine access for still more. Often my patients bring it up without me even asking; “Dr. Webb, when do you think the clinic will have the vaccine available?” Others, when I ask, are excited to be scheduled, or added to our call list for when more doses do come in.

For others (and certainly not just among my Black patients), hesitancy about the vaccines is indeed a factor, and I have been intentional about carving out time in the midst of busy clinic days to have these conversations.

For me, the first step in any conversation about vaccine or treatment hesitancy is acknowledgment, and this is particularly true when speaking with my Black patients. Though I was becoming aware of this area of our medical history for a long time, I was hesitant to discuss it openly, fearing it would come off as insincere or virtue signaling; until one day it just burst out.

I was in the COVID-19 outdoor clinic and discussing a patient’s cough and cold symptoms. My patient, an African American woman, was hesitant to get a nasal swab to test for COVID-19 despite having very classic symptoms (though thankfully her test ended up being negative). When asked about her concerns, she said something I had heard from hundreds of patients of every race, age, gender, and background; “I just have a hard time trusting doctors” (I should mention here that the fact I, a doctor, had heard it hundreds of times points to how widespread this problem is; how many thousands of patients felt that exact way but didn’t feel like they could say it to me?). Normally I would respond by saying “I understand” or “I think a lot of people feel that way, let’s talk about it”; measured and time-honored responses that preempt any defensiveness I might feel and allow the conversation to keep moving forward. But that morning I had gone for a run before clinic and listened to Medical Apartheid for about a half hour, and without thinking whether it was wise, instead I burst out with, “Well how could you as a Black woman, when there’s been so much research abuse by the medical field?!” Before I even had time to consider whether I had just stuck my foot directly in my mouth, she grabbed my arm and said “Yes! Exactly!”

Without adopting it as a stratagem, since then I’ve felt much more free to discuss that history with my Black patients (and not just in the context of the COVID-19 vaccines), who of course already know it but might not think I know it- or am willing to admit it- as a white doctor. And I’ve been disappointed, thought not surprised, at how many times my Black patients have told me it’s the first time they’ve heard a doctor even acknowledge Tuskegee, much less all the rest; historical groundwork that has shaped a huge part of their paradigm for interacting with modern medicine, and their doctors, including me, have never even mentioned it or recognized that it exists. When we confess that history we are working to rebuild trust, and we sincerely signal our intent to do the difficult work, individually and as a field, to correct the abuses of the past and present and ensure they never happen again.

Next, I will often share my personal experience of being vaccinated (and that of my wife, a nurse) with my patients. I received my first dose of the Moderna vaccine on Christmas Eve, and my second just last week. As a healthy, 35 year old man with no major risk factors, even my privileged access to the vaccine is understandably controversial, and there is a strong argument to be made for my doses going to someone who needed them more. I wrestled with this for days before getting vaccinated. Ultimately, I decided I needed the vaccine because as a primary care doctor it is vital that I can look my patients in the eye and tell them I would never recommend that you accept a medical intervention, vaccine, or medicine I wouldn’t take myself or advise for my own family.

This is absolutely true, though it isn’t always possible; so far I haven’t needed my appendix removed or required anti-seizure medications or chemotherapy, yet of course I would recommend those for patients who need them. But it is true about the vaccines, and vitally important in the context of our climate of medical disinformation. But with my Black patients in particular there is an additional layer of significance; to the extent that these vaccines are seen as “unproven” (they are not unproven, just commonly understood as such: safety trials involved 10 times the number of participants than normal vaccine safety trials!), it was important for me as a white doctor to show my patients that I am willing to go first on their behalf, when historically it has been Black Americans that have been tricked or forced into going first in order to protect people who look like me. As Harriet Washington says, it is only since Western Physicians and researchers have abandoned the tradition of subjecting themselves to potential harms before they were willing to subject others that research abuse has become so common.

Then I will spend some time, if the patient has specific concerns, answering questions about the COVID-19 vaccines and helping them see through the misinformation around them. The same legitimate misunderstandings and unanswered questions, wild speculations, deliberate lies and mischaracterizations, and outlandish conspiracy theories that I see every day and try to combat on my blog (see my slowly expanding COVID-19 Vaccine Questions & Answers and more importantly the list of resources there) are being sent to my patients, regardless of their skin color or background. We talk about those myths and I try to use this area of semi-expertise to benefit their decision making as well as I can. I often share a two page handout on the most common COVID vaccine myths, that goes into far less excruciating detail than I do on the blog, knowing my patients can ask me for clarification if they want more information. We also talk about the efficacy of the COVID-19 vaccines, the dangers of the virus, and my firm belief that this is our best path forward out of this pandemic.

Finally, I point my patients towards exactly the same types of resources I shared at the beginning of this article; but here is where my relationship with the patient is a key factor. I have been practicing for 5 years now since completing my residency and have many patients, including many Black patients, who trust me as their primary care physician more than they trust any other individual who could speak into their medical decisions or their healthcare fears or anxieties. Though I will still point them towards the incredible resources that come from my Black colleagues, it is to support the work of trust-building that we have already been doing within our patient-doctor relationship for years. Those resources are influential and reassuring, but my word is also valuable to them specifically because they have seen me work diligently on their behalf and engage with them in a partnership to further their healthcare goals and protect their dignity and autonomy.

Other patients I don’t have that kind of relationship with yet. Either we’ve only had a few visits together or I am seeing them in a context outside of their usual clinic; our COVID-19 outdoor clinic or covering for their normal doctor. In those settings we still work to build trust, but I have to be humble and realistic about how much this can be accomplished in 15 minutes (though you’d be surprised). When I and a Black patient I barely know talk about the COVID-19 vaccines, I explicitly state the fact that we are probably both thinking: that I can’t as a white doctor tell them ‘you should get vaccinated’ and expect to be believed by default, or feel entitled to be believed, by virtue of my title or position, my medical education, or my presumed expertise. And though I hope that through our conversation about the history above and just as importantly through sincerely listening to their concerns and working hard to care for their medical needs I will have built some degree of confidence and trust in my recommendations, nevertheless it is in those situations that I have to lean most heavily on the outstanding work that my Black physician and scientist brothers and sisters have already done in dispelling the COVID-19 vaccine myths and empowering fellow Black Americans to make the best and most informed, empowered choices about getting vaccinated. At the end of those conversations, like the beginning of this blog post, my most important role is getting the resources that have already been created by those Black leaders, without any input from me whatsoever, into the hands of people who share with them a history of medical abuse and subjugation but are striving to claim ownership of their health narratives and use every good tool and resource available to defeat this pandemic and end its inequitable impact on Black Americans.

Dr. Simone Gold and the “Experimental Vaccines”

Introductory Comments
(skip ahead if you just want the minute-by-minute analysis)

Dr. Simone Gold and America’s Frontline Doctors

The video below is going viral right now, spread mostly by private text and social media messages. I’ve had it sent to me by several people in the last week, both doctors who were frustrated with the obvious untruths but too busy (with the pandemic) to formulate a response, and by people with less scientific training who knew the information didn’t sound right but didn’t quite know why.

The talk is from The Stand, a mass faith healing and miracle event put on by known religious hucksters in Florida. False Teachers and theological misinformation are another passion of mine and have been for much longer, ever since I attended a Benny Hinn crusade for a Sociology course. But even though there’s also a pandemic of heresy in the United States right now, it’s the medical aspects of Dr. Gold’s talk at The Stand on January 3rd that we are focused on today.

For an introduction to Dr. Gold and her organization I would encourage you to glance at the response I wrote to their most popular video, a press conference they gave at Capitol Hill back in July. This was the video where Dr. Stella Immanuel from Houston spoke about hydroxychloroquine.

America’s Frontline Doctors (I guess I don’t count?)

This group has been speaking and writing about COVID-19 since at least May, when they wrote a letter comparing the COVID-19 pandemic to a Mass Casualty Event, where presumably the 437,000 Americans who have died from the pandemic so far would be in the “black” category of mass casualty triage; not worth trying to save. The group also includes Dr. Dan Erickson, the California urgent care doctor who spoke out about how the virus is not-dangerous and how most of California had already had it… Back in April. To Dr. Erickson’s credit, his later statements have been much more measured, and based on his sincerity in the original press conference I actually wouldn’t be surprised if he at some point quietly recants his analysis, which was founded on extremely flawed epidemiological assumptions. To date, there have been 40,192 COVID-19 deaths in California.

Finally, you may have read about Dr. Gold’s recent arrest for her involvement in the attack on the US Capitol, which occurred just 3 days after her appearance at The Stand, during which she gave a brief speech again condemning the vaccines and encouraging people to get ahold of hydroxychloroquine. Dr. Gold has since stated that she regrets being involved in that event. My sincere hope for Dr. Gold is that this series of events will force her to consider not just that particular action, but also her stance on the pandemic over the past year as a whole, and to reexamine the evidence, reflect on the harm that has been done by medical misinformation and the people who have died as the result of attending to it, and maybe even become a leading voice for reform from within the COVID-19-denial movement. Dr. Gold is sincere, funny, and winsome as a public speaker; it would be the greatest thing in the world if after this she chose to use her platform to help people take the pandemic seriously and love their neighbors by following common sense, effective transmission control measures.

She, in this case.

Layout of this post

This is a very long post and I don’t expect everyone to read it all the way through. I’ve divided it up into a minute-by-minute breakdown with time stamps for easy reference. If there’s a section of the video you want to read a counterargument or clarification for, just look at the time on the video and scroll to that part of the post.

I’ve also separated it into large sections which I’ve hyperlinked below in the “contents” section. Though Dr. Gold jumps around a bit (that’s not a criticism, I jump around way more when I speak in public), it is possible to separate her talk into some big chunks, so that if you are really only interested in particular topics from her video you don’t have to watch the whole video or read the whole post.

Finally, I’ve included the video itself in my blog post. Just as we have to fight the COVID-19 pandemic on an individual level by providing excellent patient care to those affected and on a population level by encouraging transmission control measures like masking and social distancing, misinformation can be fought in two ways; containing the spread by taking down harmful and misleading content, and by engaging with that content and providing thorough analysis. I have mixed feelings about the first method, and as a primary care engaging directly has been the focus of all of my training and my life’s work. So if Dr. Simones Gold’s video gets taken down on other platforms, it will be up here; and all I ask is that if you are going to watch the video on my blog you’ll also read the blog. Not doing so is tantamount to admitting you are only willing to consider one side of these arguments, and I’m betting that’s not consistent with how you see yourself; all of us want to be fair and reasonable in our judgements.

Contents

Introduction
Dr. Simone Gold and America’s Frontline Doctors
Post Layout (you are here)
1 thing I’m going to do and 1 thing I’m not going to do
3 things Dr. Gold is going to do

Video

Minute-By-Minute Analysis
Part 1: Preliminaries, Hydroxychloroquine, and Masks
Part 2: “Experimental Vaccines”
Part 3: COVID-19 Vaccines and Racial Healthcare Disparities


1 Thing I’m going to do and 1 Thing I’m not going to do

First, I am going to try to be very fair to Dr. Gold in this analysis.
I know that Dr. Gold has a lot to gain from her minority position on COVID-19 issues (becoming the niche go-to medical expert for millions of people who want to believe what you are telling them can be very profitable), but also a lot to lose, which she touches on in the video. Yes, it’s almost a certainty that we will see a book or another political bid from Dr. Gold in the future, and someone whose videos have been shared tens of millions of times and who has successfully sold medication from her website before being forced to stop might sound a bit hollow when complaining about what a risk she is taking by “speaking out”. But the truth is that there is risk. She has been arrested, albeit for her involvement in an attack on the US Capitol and not for anything she has said about COVID-19, and considering everything she has said and written over the past year I’ll honestly be surprised if she keeps her medical license, and I could honestly argue either way as to whether or not that’s actually fair. A doctor friend and I have often morbidly joked that if we didn’t care about morality or medical ethics, we could make lots of money as MD’s; we’ve all seen people do it, endorsing some expensive supplement or offering unproven treatments at exorbitant prices. But I do not believe that Dr. Gold has simply conducted a market analysis and decided there is more money in spreading COVID-19 misinformation than in quietly working as an ED doc, treating disease and alleviating suffering. She must earnestly believe at least some portion of what she has said in this video and has been saying since early in the pandemic, or she would not take the risks; and that is a sympathetic position. I disagree with her on many points, I think it’s pretty clear that she is wrong and why, and that as a physician I think she ought to know better; but I believe she is sincere in a certain way, and wish rather that she could see the truth than that she would simply stop spreading falsehood.

So I’m going to try to be fair. When I perceive that Dr. Gold is speaking from a sincerely held belief I’m going to say so, and when I can’t tell I’m going to assume that she is. We will look at why, in her personal experience and clinical practice, she might be justified in believing some of those things (though as a doctor she has as much access as any of the rest of us to high quality information to put her limited personal observations into a broader context). But there are also times in this video that it is clear she is either lying, engaging in shameless hyperbole, or spreading misinformation she doesn’t believe because she thinks her audience will. Indeed, her conviction in this video seems to be that no COVID-19 myth, no matter how far out, is too ridiculous to include. She basically admits this at several points and I want to be fair and give her credit when we get there; but I’m also not going to shy away from stating that she is almost certainly lying at the times when that is clearly the case. People will die because they attend to this video, and I think being fair to her context and intentions has to cut both ways.

Second, I am not going to rehash arguments that have been made thoroughly and extensively elsewhere.
I’ve written on the evidence of hydroxychloroquine’s ineffectiveness for COVID-19 (Budesonide too) more times than I can count and won’t do it again. Instead I will shamelessly link to my old posts, or better external sources, which you can read if you wish. I’m also not going to argue with every point Dr. Gold makes because she throws out almost every COVID-19 conspiracy theory and myth at some point in the course of the video, even those that have been systematically disproven over and over again. I may touch on masking and other issues very lightly and provide links, and other sections I may skip over almost entirely. This video is 1 hour long and the focus needs to be on the vaccine misinformation, which she begins sharing at about 23 minutes in; so I’m going to pass some things by. Silence does not imply agreement or ceding the point, but I’ve got a full time job and a family I really like, and don’t have 10 hours to spend debunking this video. If there’s a point she makes that you find particularly salient but that I don’t get to, please say so in the comments and I’ll see what I can do.


3 Things Dr. Gold is going to do

I usually like to only debunk/analyze as we go, but this video is so long that we will save a lot of time by touching on the 3 most common “tricks” Dr. Gold uses in her talk. I don’t mean “tricks” as in deception, though some are that; I mean these are debate tactics or rhetorical maneuvers that make her arguments more convincing to the unwary listener without really adding to the actual content of her presentation. I think if you’ll watch the video with these 3 things in mind and can see when she is doing them, you’ll find a lot of this content far less convincing than if we merely reacted to each particular instance.

1. The COVID-19 virus is dangerous or not dangerous when it suits my point.
This is one we’ve seen consistently with misinformation throughout the pandemic, especially from doctors and especially when talking about unproven treatments. The very same doctors who will tell you that the virus isn’t really dangerous and you shouldn’t wear a mask or social distance will then turn around and rely on extremely small numbers of patients to prove that their intervention is the cure, assuming those patients would have had a bad outcome without it.

But you can’t have it both ways. You can’t use a high recovery rate among certain demographics as proof that preventing the virus simply isn’t necessary, and then use a patient in that demographic recovering as proof that your treatment works. You can’t say that the death rate for a 25 year old patient is “0.02%” so you shouldn’t even worry about it, as Dr. Gold states later in the video (will look at the context and impact of these numbers at that time), and then turn around and say that the 25 year old you treated not dying proves your treatment saved their life.

This is a true contradiction, but it’s explicable when you realize that the doctors who hold these contradictory views derive them from two separate thought processes. When talking about the pandemic being blown out of proportion, they are speaking from a political and economic standpoint that wishes, as we all wish, to get life back to normal as soon as possible; the evidence of the danger of the pandemic, which has now killed over 430 thousand Americans, simply cannot change that philosophical belief, no matter how overwhelming the evidence becomes. But when they are talking about their favorite treatment being ‘the cure’ for COVID-19, they are consulting extremely small samples of patients that constitute nothing like substantial anecdotal evidence, much less reliable data. Besides the fact that most of America’s Frontline Doctors are nowhere near the front line (no pay wall but you have to register for that article. Sorry), the way they have admitted to selecting their patients and “diagnosing” COVID-19 make their clinical experiences entirely unreliable. We talked about that more with Dr. Stella Immanuel’s and Dr. Ivette Lozano’s viral videos.

Watch for this as you go through Dr. Gold’s talk. In each section, is she working from the assumption that the virus isn’t really dangerous and therefore you don’t need masks or vaccines, or that the virus is universally deadly and therefore it’s vital that you have access to unproven treatments for it? Most importantly, is she working from a consistent assumption or does it fluctuate based on the point she is trying to make?

2. Everyone is lying to you but me.
I know it feels really calloused to even point this out, but I’d argue it’s more calloused to actually engage in this type of argument. But Dr. Gold does this over and over again. Each time she tells you that historically truthful sources of information like the WHO or the CDC are known for dishonesty or unreliability, each time she tells you that all the doctors and scientists are ‘in on it’ or ‘have fallen for it’ or ‘have drunk the Kool-Aid’, she is saying the traditional sources you would get your health information from can’t be trusted anymore because they are either lying or have been deceived themselves. This is a transparent, mean-spirited, and petty rhetorical trick; it’s also devastatingly effective when you are the one telling people what they want to hear. “Trust me, not them” is not a good standard of evidence, but it works when someone already wants to trust you, as the people she is speaking to almost certainly do. They are comforted because it alleviates the cognitive dissonance of going against the medical experts and what you are being told by people in your own community. If you don’t know them or don’t like them they are lying; if you like them and know them, they have been duped. It gives you a position of both moral and intellectual superiority to believe that you alone are in a position of being both knowledgeable and truthful, and that is the gift Dr. Gold is giving to her audience. It is seductive.

There is also no counterargument that works against it, because if you don’t know me then you can just think that my whole rebuttal is simply lies (ouch), and if you do know me and like me you can think that I’ve been duped myself; that’s the whole point of the ‘you can’t trust anyone but me’ trap. The only way to avoid being deceived by this is to consistently think of this video in the context of your own life and not in a vacuum. You know people who have been harmed by COVID-19, even though Dr. Gold would tell you those were anomalies or they were really harmed by something else altogether. You probably knew people who died from it who weren’t going to die this year otherwise, even though she claims that’s the only people this hurts, people who would have died anyway.

And you know medical professionals. Dr. Gold and a handful of doctors are taking an extreme minority position and telling you that over a million other doctors are wrong or lying; that we are part of the medical establishment and being told what to do by the government, big pharma, and whoever else (by the way, I’ve literally never been told what to do by either the government or a pharmaceutical company when it comes to practicing medicine. Not once). But you know some of those people and you don’t know Dr. Simone Gold. Those other doctors aren’t nameless, faceless, nefarious intellectuals. They are your local Family Medicine doc or Pediatrician you go to and bring your kids to and ask for advice on medical issues ranging from the deeply concerning to the fairly mundane to the kind of embarrassing. They are the nice young resident who took care of you in the ER that time, or the grumpy specialist that nevertheless got to the bottom of your problem. And yes, they are the doctor you didn’t trust or had a bad experience with; but so Dr. Simone Gold’s allies might be. For hundreds of people in Minden, Louisiana, they are that goofy but good natured kid you taught in Sunday School and Youth Group or bought Boy Scout popcorn from for all those years. For some church members in East Texas, they are that son-in-law of the church secretary who visits with his beautiful family whenever they are in town. And for lots of random people across the country, they are that young man who stopped to help you change a tire or gave you a lift when you were hitching, or helped you pick out an over-the-counter medication when you were confused at the local pharmacy even though he absolutely shouldn’t be giving out medical advice in the middle of Wal-Mart. Maybe you don’t know TJ Webb, MD, but you probably knew people as children or as teenagers or young adults who went on to careers in science, epidemiology, and medicine. Those are the people Dr. Simone Gold says are lying to you, and you only have her word to prove it.

That is the context in which you have to think about this claim that ‘everyone is lying’; the context of the real world, where each of those ‘lying or duped’ medical professionals and scientists come from somewhere and have real-life relationships, souls, and histories. We are not a nameless, faceless, monolithic establishment; and disagreeing with Dr. Gold doesn’t make us one.

3. Calling misinformation “truth” and truth “misinformation.”
This is the simplest one but also the most insidious. Dr. Gold spreads misinformation throughout this video, but she is going to claim that her talk is specifically intended to correct or debunk misinformation. This is a false equivalence; she wants to put the information she is sharing, which is believed by a tiny handful of doctors and scientists, on equal footing with the research and clinical experience of millions of scientists, physicians, nurses, epidemiologists, and researchers. Speaking from a widely debunked and extreme minority position, she wants to turn all things COVID-19 related into a ‘he said / she said’ situation and ask you to choose between the two as equally valid and scientifically supported views.

And in a way that’s ok; when presented with false information like that which Dr. Gold shares in this video, you really should decide for yourself based on the evidence. But please keep in mind what the implications are of accepting one or the other. If you decide that Dr. Gold is truthful then you are in effect saying that you agree that there is a wide-ranging conspiracy to deceive the public and cause mass suffering, which involves almost every single doctor, nurse, and scientist you know. And if you believe that, that’s fine; some people do prefer conspiracy theories, or even just want that to be true because it would mean that life could get back to normal sooner. But let’s not pretend that the real life experiences of millions of generally altruistic doctors and nurses is equivalent to the fringe view of a few overtly political physicians. At the very least, the burden of proof rests with the latter.


*WARNING*
The Below Video Contains oh just tons of incorrect and misleading information.

If you are going to watch the video, please also read a counter-argument; either mine or someone else’s.


Minute By Minute Analysis

Part 1: Preliminaries, Hydroxychloroquine, and Masks

0:39 “Experimental Vaccines”
Well that didn’t take long. Dr. Gold will consistently call these vaccines “experimental” because all of us are afraid of being guinea pigs in some science experiment. She is mischaracterizing them and we look at that in detail later on, but she wants you to adopt her terminology now because even the idea of the vaccines being experimental will convince some people not to get them. People will die because of this video.

1:03 America’s Frontline Doctors
Dr. Gold’s organization has been spreading misinformation about the pandemic for going on a year now; here is the first instance of her claiming that they are trying to combat it. Truth is lies, lies are truth.

1:25 “Groups of physicians, scientists, and government agencies lying to the American people”
This is the first instance of “everyone is lying but me”, but certainly not the last.

1:50 ‘The NIH is lying when it says that unless you are in the hospital requiring oxygen there is no treatment available
Dr. Gold is going to spend the next few minutes talking about hydroxychloroquine, and you can read my analysis of these claims in any of the many posts where they’ve already been addressed.

But this claim specifically is that the NIH says there is no treatment unless you are in the hospital and on oxygen. Well, here are the NIH treatment guidelines, and I’ve included their summary table below.

For patients with mild to moderate illness who are not hospitalized, there is some decent evidence of monoclonal antibody therapy and I have referred several patients for this just this past week. This is the same treatment then-President Donald Trump received when he had COVID-19. For patients in the hospital and not receiving oxygen, they recommend remdesivir for those with a high risk of disease progression. And of course, for all patients we are providing counseling on over the counter treatment, supportive care, and anticipatory guidance when they are seen, which any doctor would tell you are the mainstays of treating any illness, whether specific medications are prescribed or not.

So, 1 minute and 50 seconds in we have our first example of Dr. Gold giving a demonstrably false statement. The proof is before your eyes; the NIH treatment guidelines do not say no treatment is available unless you are in the hospital and on oxygen. Will you still give her your absolute trust for another 54 minutes?

2:20 “We were promptly de-platformed”
This is true; there is no denying that the America’s Frontline Doctors Capitol Hill speeches, and most famously Dr. Stella Immanuel’s hydroxychloroquine speech, were taken down from Facebook and YouTube. Again, as that video was full of dangerous misinformation, it’s hard to feel bad about it; but it certainly lends credence to their claims of censorship (by private companies and not by the government, but still) and in certain peoples’ eyes lends an air or forbidden truth to their comments.

I would much rather have the arguments understood and then analyzed. I wasn’t able to post a video of that talk but you can read the transcript and my analysis here.

2:29 “This is a crime against humanity.”
Wait, YouTube taking down their video was a crime against humanity? Hmm…

I’m being facetious; she clarifies that it’s the massive disinformation campaign around COVID-19 that’s the crime against humanity. I happen to agree with her, but we fundamentally disagree about who is a part of that disinformation campaign.

2:52 “The vast majority of deaths in America would never have happened.”
Uncanny, we absolutely agree again. When you look at the death rates around the world, every nation, and especially those that took the pandemic very seriously early on, has faired much better than the USA. But the key is prevention of transmission with masking, social distancing, and now vaccines; not ‘give everyone hydroxychloroquine’.

When in your life have you heard a doctor say it’s better to get a deadly disease and then treat it than to avoid getting it in the first place? We are accused of that all the time, but I’ve never actually seen it happen until now. Again, the treatment she is espousing here doesn’t actually work, but that’s beside the point. The very people who will share this video where Dr. Gold promotes unproven treatments and warns against safe vaccines will un-ironically go on to post comics like this one:

Our first day of medical school was actually just a bunch of ice breaker games and a super annoying scavenger hunt that we lost because my friend Jason kept on getting lost, but whatever.

3:09 “You need to understand the magnitude of the lie…”
What Dr. Gold is doing here (besides helping fill up her hour, which can be a real challenge sometimes), is repeating to a select audience- both those at this faith healing event and those sharing her video on the internet- misinformation and conspiracy theories they already agree with. This helps solidify her position as a truth-teller and lends additional credibility to the real point of her talk, the concerns she is going to share about the vaccines later. We will go through them as quickly as possible.

3:26 “Its real name should be…”
There’s no important information or misinformation here one way or the other. We do not universally name diseases after their location of origin, though it is sometimes a factor, just like the person who discovered it is sometimes a factor in naming. If anything, we are getting further and further away from eponyms in medicine, and where many people would have talked about “Hansen’s Disease” in the early 1900’s, nowadays we just say “leprosy” like they did in the Bible, except for a few test questions during second year of medical school. Naming conventions for diseases in the age of microbiology focus more on either the name of the pathogen or the syndrome that it causes.

For instance, the name of the dangerous Coronavirus disease that was first identified in Foshan China in 2002 was “SARS”; Severe Acute Respiratory Syndrome; it was never called the “Foshan” virus. In contrast, the next dangerous Coronavirus we encountered in 2012 was called “MERS”; Middle Eastern Respiratory Syndrome, based on the region it was discovered in. The name of the novel Coronavirus we are fighting tooth and nail against now is SARS-CoV-2; Severe Acute Respiratory Syndrome Corona Virus 2, because, you know, it’s the second one. The name of the syndrome is COVID-19 for Coronavirus Disease 2019, which I admit is a little bland for something that has devastated the world.

The only times the virus is called the “Wuhan Virus” (or the more overtly racist “Kung Flu”) is by those who wish to make a political statement; calling it the “Wuhan Virus” is politically or ideologically motivated, not the other way around. Here Dr. Gold is simply making a show of solidarity with those who would like to call it what former President Trump often called it; there is no important ground here, only signaling to her audience which team she is on.

3:38 “Before we discovered…”
What was discovered was that it is a coronavirus similar to the one that causes SARS, not that the Chinese government didn’t like the name “Wuhan Virus.” Remember, it is called COVID-19 and SARS-CoV-2 around the world; the narrative that the US is in China’s pocket (not my field of expertise) simply does not explain the naming conventions for the pandemic.

3:55 “They called it a coronavirus because it is a coronavirus, but that became very confusing to doctors and scientists…”
Nobody was confused. This whole narrative is really weird and insincere.

4:03 “We used to use coronavirus on our charts when we meant a common cold.”
Look I realize I am splitting hairs here, but no. If you did a viral respiratory panel and it showed a coronavirus, sure, you would document that; but otherwise we call those colds “viral upper respiratory infection” or just “cold”, or if it is causing a more specific clinical picture, “viral bronchitis” or “viral bronchiolitis”, etc., or if we are really being lazy just “cough, sore throat, and rhinorrhea (runny nose)”.

When I started listening to this last night and Dr. Gold got to this point, my wife (a Registered Nurse) called out from the other room, “Did she just say we use ‘cold’ and ‘coronavirus’ interchangeably?!” Yes, she did. And no, we don’t.

Again, it’s a non-issue, but I was annoyed by it. Sorry, moving on…

4:59 More Hydroxychloroquine
I’m really going to limit myself to a few comments on this section because I’ve already linked to my other hydroxychloroquine articles above. The biggest things that stick out here:
5:11 We don’t give any medicine out like candy.
5:18 Treatment and prevention of Malaria is a common use of chloroquine and hydroxychloroquine because they have been proven to be effective against that disease. Comparing this to using it to treat COVID-19 is like saying you don’t understand why a doctor won’t give you penicillin for your high blood pressure when they give it out all the time for strep throat. Carefully deciding which medications to prescribe for specific conditions, and then carefully discussing the risks and benefits of them with our patients, is modern medicine. Is Dr. Gold really saying that if a medicine is helpful and safe for some people and conditions it’s helpful and safe for all people and all conditions? If not, then surely she would admit that we have to follow the evidence here.
5:48 I really shouldn’t have to say this, but the key difference here is that Malaria is common in Sub-Saharan Africa and uncommon in the US. She says it herself, but the issue isn’t consumer demand but rather the ubiquitousness of the disease it treats. That said, if hydroxychloroquine really were the miracle drug for COVID-19 that Dr. Gold and others have claimed, I’d join them in calling for it to be OTC with appropriate pharmacist warnings. Sadly it isn’t.
6:43 We have not been hearing about it being unsafe for 10 months because of an organized misinformation campaign against hydroxychloroquine. Does she ever offer a credible theory as to why such a thing would happen, why doctors wouldn’t want patients to have access to this medicine if it worked? The truth is we heard about it 10 months ago as being something we were hopeful might work, and then were sad when the evidence showed it didn’t. We’ve only continued to hear about it since then because doctors like Dr. Gold continue to build conspiracy theories around it.
6:51 “You’ll be suspicious of everything that follows” And that is the point of it being included in this talk.

7:15 “She was so much better”
Here the virus is dangerous, which proves hydroxychloroquine is effective because this patient got better.

7:33 “My medical director called me the next day”
I absolutely will not try to dissect Dr. Gold’s personal experience here and claim that either she or her medical director was in the right. For one thing, we simply don’t have enough facts, we don’t even know what point in he pandemic she is talking about; I know some very good doctors who were using hydroxychloroquine back before any major studies had been done because there was hope the evidence would show it was effective. Those doctors don’t prescribe it anymore, because they have been convinced by the evidence.

What I do want to say is that her example of the medical director coming to her seems intended as a callback to horror stories we have all heard about a hospital administrator or business consultant telling a doctor or nurse how to practice medicine, usually motivated by profits. That is wrong every time it happens, and those people deserve to get fired, fined, and in some instances, serve jail time. I’ve never had one of those situations, but I’ve been in some that came close.

But this isn’t one of those stories. My medical director is an excellent physician who has been practicing a lot longer than I have; I often go to her for professional and medical advice. If she were to offer feedback or even correction on some treatment I was providing that was not supported by evidence or seemed to be due to political motives rather than evidence-based medicine, that would be part of her job. I might not like it. I could argue my case. I could appeal to any of a number of internal resources. I could lay down the gauntlet, do it anyway, and let the chips fall where they may. But I could not accuse her of overstepping her bounds. When she says this is against the law or an example of a ‘corporation practicing medicine for her’, she is knowingly wrong.

7:55 “You haven’t read the science the way I have, you’ll change your mind in a couple of months when you get a little wiser.”
Yikes. I’d say ‘that didn’t age well’ but she just said this 2 weeks ago.

8:38 “The reason he said I shouldn’t prescribe it was because the insurance company didn’t want us to.”
Nope, I don’t believe this for a moment, for 2 reasons. First, Dr. Gold is shamelessly promoting a well worn lie that pharmaceutical companies tell doctors how to practice medicine. It’s commonly believed, it crops up on tv and in movies constantly, and it’s almost an underlying assumption in many peoples’ interactions with healthcare; and it’s 0% true.

I spend countless hours each month helping my patients navigate around their insurance company’s arcane pharmaceutical rules and find the best way to afford their medicines regardless of their insurance status. I often prescribe a medication to one pharmacy, and then print the prescription and a coupon for another pharmacy in case the insurance doesn’t cover it. I pull up GoodRx.com or the Wal-Mart $5 generics list and we tally up the cost of their meds to find the cheapest price and make sure they can afford it. You know what I’ve never seen a class, a lecture, or even a powerpoint slide on and have never given a hoot about since the first day of medical school? Pharmaceutical or insurance company profits. Don’t confuse the broken system with the people who are fighting against it every day.

But the second reason is a lot more straightforward; they are in the Emergency Department, not inpatient in the hospital. The patients are filling their prescriptions at some pharmacy somewhere separate from the hospital, and the medication costs about $15 for a month supply with a coupon; the insurance company doesn’t have to pay for it if they don’t want to, and the ER docs will probably never hear about it. So any intervention or confrontation over this medicine was almost certainly because of the paucity of evidence for it working, not because of financial issues. If Dr. Gold at some point shows documentation that confirms this narrative, I’ll be shocked; I’ll also publicly recant this objection. But it seems to me that she is just retracing a well trodden but false narrative about the toxic control that pharmaceutical and insurance companies have over doctors.

9:17 “My days at that particular hospital were numbered.”
Listen, I can relate here; I once quit an ED job because of financial issues too. The issue? I found out that ER company was sending their patient’s bills directly instead of going through insurance, and worse, marking up the charge for physician services by about 150 to 300%. I never scheduled another shift. So even if her narrative above isn’t true, if she felt that it was I could empathize with her feeling like her career at that hospital was done.

10:22 “It got 20 million views because human beings recognize truth.”
I would be very, very careful about arguing that views=truth. I’m sure there are a lot of youtube videos out there that engaged in less than perfect truth telling but do pretty well. But it’s a nice thought.

13:00 “You have to push back against tyranny.”
Dr. Gold is here advocating against wearing a mask and comparing it to tyranny without offering a single scrap of evidence. The evidence that masks help prevent the spread of COVID-19 is absolutely overwhelming (it’s dated, but it was overwhelming when I first wrote about it back in June, and the evidence is only stronger now). This misinformation video and others like it will cost lives; but she is talking to a group of COVID-19 deniers and advocating for masks, or even remaining neutral, isn’t an option for her.

13:24 Not wearing a mask on behalf of others is a very strange argument.

15:00 “Whether you have COVID or you don’t have COVID you can get yourself a prescription…”
That’s called a pill mill, folks.

15:38 “People just want to go back to normal lives.”
Dr. Simone Gold is absolutely correct here. It’s one of the reasons this medical misinformation is so very seductive, because it speaks directly to our hopes; specifically our hope that we can finally be done with all of this. But the question isn’t whether or not we should be afraid; we shouldn’t. It’s whether our actions are kind and wise, and that in turn is based on whether our information is actually true. Every day, with every patient I test for COVID-19, I tell them not to be afraid; and then we talk about how they can protect themselves and their loved ones from this very dangerous virus.

16:17 “The vaccine doesn’t stop transmission.”
If I get the vaccine, can I still transmit/spread the virus?

16:21 “It actually changes nothing.”
Again, this simply isn’t true. Vaccines are still our best path out of the pandemic while limiting death and suffering. If you are vaccinated, your risk of both death and long-lasting medical side effects from the virus is significantly lower. If your grandparent is vaccinated, your risk of giving them the virus and them dying from it is incredibly lower. No, a few million people having the vaccine has not yet changed the pandemic substantially for everyone; but thankfully that is the path we are on.

17:03 “According to the CDC which is not known for it’s honesty.”
“Everyone is lying to you but me.” There have been multiple examples where the CDC has published confusing, conflicting, or poorly communicated information throughout this pandemic. Sometimes that was because of incompetence, other times because the best information available was just changing so rapidly. And at other times it was because high ranking officials in the Trump administration, with no medical background, were controlling what information was being put out.

If you have any specific examples where the CDC actually lied to the American people during this pandemic, please leave them in the comments. Let’s not just take Dr. Gold’s word that all of the hard working scientists, doctors, and public health workers at the CDC are liars become she’s telling us information that tickles our ears.

And by the way, if you want to see how these numbers Dr. Gold is getting ready to share compare to what the CDC has been saying for months, have a look at this graphic from as far back as October. Don’t let someone tell you’ve been lied to when you haven’t been; check the original source.

17:07 Survival Rate by Age
At this point Dr. Gold spends a few minutes talking about the survival rate for COVID-19 for various age groups. Earlier when talking about hydroxychloroquine the virus was very dangerous; it was remarkable that her patient got better after taking the medication. Now the virus will become benign again except for small percentage of the population.

There are some fine points of epidemiology that we are going to have to guess at since Dr. Gold doesn’t give us complete information. For instance, we will assume she means the Infection Fatality Rate, which includes estimates of asymptomatic carriers of the virus, rather than Case Fatality Rate, which is just those who develop the COVID-19 syndrome; it’s the lower number and, for the point she is making, the best one to use. We also don’t know where she is getting her numbers from, as we will see in a minute.

Two more tricks to look out for (again, I don’t mean ‘tricks’ as in intentionally deceptive, just that these are rhetorical tools to make the data better reflect her side of the argument). First, Dr. Gold is going to give you the survival rate, not the mortality rate. This is incredibly important. When Dr. Gold tells you “95% of people over 70 survive,” you are reassured; the way that is phrased, it’s easiest to see yourself or your loved one in that 95%. If you were to say “5% of people die,” you would be sharing exactly the same information, only now it is too easy (for Dr. Gold’s purposes) to see yourself or your loved one in the 5% group that will die; you might want to take some precautions, like wearing a mask and social distancing, which in general Dr. Gold is against. Indeed, when I read survival rates like 99.5% and 95%, I get really worried; those mortality rates are just astronomical compared to any virus we normally face.

Second, Dr. Gold is grouping all ages from birth to >100 into just 4 age groups. This is going to skew the numbers quite a bit. For instance, if you are 49, your ‘survival rate’ is averaged with those who are 22; but you know (just like I do at age 35) that your resistance to illness and ability to recover from infection is not the same as a 22 year old’s. I don’t think Dr. Gold is being deceptive here; she has a one hour talk and has to make the most of it, and a nuanced discussion of these numbers would take more time. Still, I think one reason for choosing such broad age groups is because the numbers fit her narrative better when they are presented that way.

17:07 Under age 20: Survival Rate 99.997%
Dr. Gold states that these numbers come from the CDC. You’ll notice she doesn’t say the same for any of the rest of the numbers, so I’m not sure if she is using the same source or different sources. But overall this agrees with the most up-to-date research on Infection Fatality Rate. One word on Infection Fatality Rate: Because you have to know how many asymptomatic cases there are (and we don’t), IFR is incredibly hard to calculate. The numbers will fluctuate some based on what method is used to estimate the asymptomatic cases. Throughout this part of the analysis I’ll present a few different studies that arrive at slightly different numbers; but that’s a good thing. Just like minor differences in the Gospels that complement each other is a proof of their authenticity, so different scientists arriving at slightly different numbers by using different techniques is a good way to know the numbers are, in general, reliable. If you had multiple scientists getting exactly the same numbers with different methods, you’d be suspicious; and you’d be right to be. Small differences are a good thing, and just one more proof that the scientific establishment isn’t pushing some big conspiracy on you.

So the Survival Rate for people under 20 is 99.997%. The US population under 20 is about 80 million, so that’s about 2,300 at risk under 20, if our estimates are accurate. So far, we’ve lost about 650 Americans under age 20 to COVID-19 (the CDC uses different age groups from Dr. Gold, so we can’t compare apples to apples here), including two children under 10 years old in Fort Worth, an hour North of here, just a few days ago. Dr. Gold says “There’s nothing to talk about” in this age group, but these are not negligible numbers. Without mitigation, we stand to see four times that number of deaths, even assuming the new variants are only as dangerous as the original COVID-19 strain.

Second, you can’t group 3 year old and 9 year old children together with older teenagers. At age 18, the Survival Rate is closer to 99.992; a mortality rate three higher than that in children.

17:15 Age 20-49: Survival Rate 99.98%
Accepting Dr. Gold’s numbers, this means that 25,400 Americans age 20-49 would be at risk; so far we have lost… about that many. So now we need to look closer at these numbers, since something is clearly off, and unlike for the birth-20 age range we don’t know where these numbers came from.

A detailed Meta-Analysis published in Nature in November estimates mortality rate for people age 20-24 at just under 0.01%, and for people age 40-49 at 0.1%; a ten fold difference. Clearly, it doesn’t make much sense to group 20-49 year olds together as one age category. 0.1% is a high mortality rate for a very, very contagious virus like SARS-CoV-2; it means that about 20,000 people are at risk in that age range. If we combine census data with the IFR estimates, we get these estimates of how many Americans would be at risk in this age range:

  • Age 20-24, IFR 0.008%, population 21.63 million
    • 1,730 at risk
  • Age 25-29, IFR 0.011%, population 23.5 million
    • 2,585 at risk
  • Age 30-34, IFR 0.03, population 22.43 million
    • 6,700 at risk
  • Age 35-39, IFR 0.075%, population 21.73 million
    • 16,300 at risk
  • Age 40-44, IFR 0.09%, population 19.92 million
    • 17,900 at risk
  • Age 45-49, IFR 0.11%, population 20.4 million
    • 22,400 at risk
  • Total Estimate from Dr. Gold’s Survival Rate: 25,400 at risk
  • Total Estimate from Meta-Analysis Infection Fatality Rate: 67,615 at risk

The mysteriously high survival rate Dr. Gold quotes when clumping together 20-49 year olds give us 25,400 Americans at risk in that age range; comparing the US population with the IFR estimates for much smaller age rangers gives us a total of 67,615 at risk 20-49 year olds. Now, we all hope that herd immunity, whether from infection or from vaccination will mean that we will never see this many deaths among this young demographic; but Dr. Gold’s incredibly low estimates of the danger of COVID-19 in this age group provide a false reassurance and bely how many lives will be saved from mitigation measures, masks, and vaccines.

We won’t get to it, but later on (at 41:40) Dr. Gold says that the only people who are dying of this are your 80 year old nursing home residents with bad hearts and other medical conditions, “It’s not your 45 year old nurse, it’s not your 35 year old police officer.Except that sometimes it is.

17:20 Age 50-69: Survival Rate 99.5%
I won’t go through the numbers for every 5-year age group again, but the further up Dr. Gold gets in these age ranges the further off the survival rates she is quoting seem to be. She quotes an infection fatality rate of 0.5% (Surival Rate 99.5%=Fatality Rate 0.5%) on average for this age range, but this is closer to the fatality rate for 55 year olds. By the time you get to 65 it’s at least 1.1% and as high as 1.4% by some estimates, which is a survival rate of 98.6%. If that sounds like a good number to you, consider the population in that age range; there are over 17 million Americans aged 65-69; that survival rate means that 240,000 of them are at risk of dying without mitigation measures.

We could do the same thing with Dr. Gold’s 95% survival rate for people over 70; that’s the survival rate for 75 year olds, not for everyone above 70. The IFR increases to as high as 15% at age 80, and continues to increase with age; that means millions of Americans are still at risk in this elder population, not to mention the hundreds of thousands who are at risk who are younger.

But even more important than all of these numbers, the fact that Dr. Gold is ignoring, which we’ve talked about over and over again on this blog, is that what makes the pandemic most dangerous for young people is its ability to overwhelm our medical infrastructure. Overwhelmed hospitals, exhausted doctors and nurses, more patients than the staff can possibly provide care for; these factors make COVID-19 extremely dangerous regardless of the Infection Fatality Rate. The COVID-19 survival rate plummets when you can’t get medical care for a severe case of the virus; but so does the survival rate of motorcycle collisions, pneumonia, diabetic ketoacidosis, gangrene, broken hips, closed head injuries, and knife wounds when you can’t get care because there are so many cases of this highly contagious virus. COVID-19 overwhelms healthcare systems and makes everything more dangerous, including itself.

17:55 “The people who die from COVID-19 are the people who are destined to die anyway.”
This is simply not true. I dare Dr. Gold or anyone who believes this to look the families of those who have passed from COVID-19 in their 70’s, 60’s… or 30’s, 20’s, or teens in the eye and tell them that person was destined to die anyway.

But I know what the counterargument will be; “those people really died from something else and it just got counted as COVID-19.” We’ve addressed this in detail before when we looked at information from COVID-19 death certificates a few months ago; those deaths really are from COVID-19. But it doesn’t fit Dr. Gold’s narrative of ‘only the old who are already dying will die from COVID’, so regardless of the facts those deaths have to be discounted. I’m not willing to discount them. 

Besides the data we’ve examined above that shows the non-negligible death rates in those in their 20’s, 30’s, etc., and the actual data you can go look at for yourself, which shows a steady progression with age and not a steep increase when you reach 80+, there is one more important piece of evidence that disproves Dr. Gold’s “people who die from COVID-19 would have died anyway” narrative, and it’s something called excess mortality. If most patients who died from COVID-19 would have died this year anyway, as the narrative dictates, then we would see little fluctuation from year to year, including 2020. 

In fact, there’s a meme with false numbers circulating on social media that claims just that, and in fact claims that the number of deaths in the US was lower in 2020 than recent years. The popular one looks like this, but I’ve been arguing with people about these numbers for a couple of months now.

One of the reasons this is convincing for people is because, in general, we are bad at estimating. Even though the deadliest month of 2020 was December, when 2,000 to 3,000 people were dying from COVID-19 per day, this data from November 22nd seemed to convince a lot of people. That’s with 39 days (10 percent) of the year left, and the deadliest days of the pandemic (at that point) to boot. But it’s actually even worse than that; this is based on data currently reported at the time, not data that had been finalized; and it takes up to 8 weeks to finalize the death count for a particular week in the US. So really, this chart is only reflecting the total deaths from about September 27th. Lest we forget how much things changed between the end of September and the end of the year:

The real numbers are much more dire, but don’t tell us anything we didn’t expect; a lot of people predicted that the US would lose over three million people for the first time ever, as far back as October and November when number of daily cases and deaths began to rise. The real number is 3,200,000, and at least 347,341 of those deaths were from COVID-19. And remember it’s only January 31st; we’ve still got another 3-4 weeks before we’ll know the final death count for 2020.


Part 2: “Experimental Vaccines”

23:10 “You definitely shouldn’t be calling these the COVID-19 vaccines.”
Dr. Gold prefers to call them “experimental biologic agents,” which honestly sounds like a term people might use for psychedelic mushrooms when they don’t want anyone to know that they are using psychedelic mushrooms. I think she’s trying to invoke Agent Orange and other biologic weapons here. But the good news is you can go ahead and call them “vaccines,” because they are vaccines.

23:17 “It is currently in it’s investigational stage.”
A lot of Dr. Gold’s vaccine information is going to try to hype up fears about the vaccines being experimental, untested, or unproven. We all worry about being ‘guinea pigs’ for modern medicine, and depending on your personal experiences, your race or ethnicity, or other personal characteristics those concerns may be very historically grounded. Thankfully, these vaccines are not experimental; not by a long shot. The vaccines have been through rigorous safety trials that were much, much larger than normal. Most trials for new vaccines have between 3,000 and 6,000 participants; these vaccine trials had 40,000 to 60,000. More to the point, about 30 million people have already been vaccinated in the US alone, including the author of this blog. In a minute when Dr. Gold says “I don’t want to be the first person to take new things…” Well, I’ve got great news for her!

If you get vaccinated against COVID-19 today, you are not in any way a part of an experiment.

23:50 “The first problem is that this brand new technology.”
This is an idea that people find particularly appealing because there is such a large kernel of truth in it. These COVID-19 vaccines are the very first vaccines to be made with mRNA (Messenger RNA) technology. That’s actually really, really exciting stuff, but the big question on everyone’s mind is, “how can we trust something so new?” Or to ask it a different way, “how could we trust a vaccine that was developed in just 9 months?

And to that I typically respond that they weren’t developed in 9 months… they were developed in 1 month.

Wait! That’s a good thing! I know that when they make all the pandemic movies about 2020, inevitably there is going to be a scene like this: All of the scientists are laying around their office in the early hours of the morning after another fruitless night of brainstorming and science experiments, surrounded by empty bags of ‘brain food’ like Red Vines and Doritos (or whatever companies pay them for product placement) and inexplicably still wearing their lab coats, when suddenly one of then sits up and says, “Wait, what if we used MESSENGER RNA TO PROGRAM THE CELLS TO BUILD COVID-19 ANTIGENS?!” Everyone sits up and says “That’s it!”, cue the Science Montage. But the truth is that the mRNA technology has been in development since the 1990’s (read this cool article about it from Stat), and was almost ready for use in vaccines when the pandemic hit.

The vaccine companies received the full genetic sequence of the SARS-CoV-2 virus in January; the first vaccine trial participants got their first doses in March, just 63 days later. The whole rest of the time from then until now was spent in clinical trials to make sure the vaccine was safe and effective.

So when Dr. Gold says this is brand new technology she is trying to scare you; but the real story is, this is brand new technology! Yay! This is the culmination of 30 years of research into how to make better, more effective vaccines… And we have access to it!

24:28 “There’s been a tremendous failure of previous Coronavirus vaccines.”
Again, this is true. You can read a lengthy but really detailed article about the state of SARS and MERS vaccines here; it even touches on the problem of Antibody-Dependent Enhancement that Dr. Gold will get to in a few moments. But there are two salient points that Dr. Gold is missing.

First, the SARS coronavirus has been around since 2002 and has killed 774 people, total. The MERS coronavirus has been around since 2012 and has killed 858 people, total. COVID-19 has been around since late 2019 and has killed 2,220,000 people. Please tell me, if you were in charge of strategically allocating resources, funds, and manpower toward vaccine research, which coronavirus would you focus on? The new vaccines are possible because for the past year the collective will of the world has been focused on overcoming the challenges in making successful coronavirus vaccines.

But second, notice what Dr. Gold just said. At 23:53 she said “mRNA technology has never ever been used before for vaccines,” and at 24:28, just 35 seconds later, she said “There’s been a tremendous failure of previous Coronavirus vaccines.” Previous failures… New technology… Didn’t Dr. Gold just give us hope that this time things will be different? I would have phrased it this way: “Unfortunately we’ve never been successful at making effective vaccines against Coronaviruses. Luckily, the new vaccine- making technology they’ve been working on for 30 years is finally ready!”

24:53 “You may have heard it called the ‘novel coronavirus’, and I never understood that. This coronavirus is 78% identical SARS-CoV-1.”
I mean, it depends on which proteins of the virus you are talking about. The genetic similarity ranges from 76% to 95-100% depending on which proteins we are talking about. I’m just… Not sure why that matters? It’s a coronavirus, so it’s going to be genetically similar to other coronaviruses. What makes it novel is the fact that it causes a novel disease, COVID-19, which has caused the worst pandemic that the world has seen since The Spanish Flu. You are 99.9% similar to the person sitting next to you, but when your friend shows you their new baby you don’t say, “whatever I’ve seen one before.”


25:16 “We’ve never been able to overcome the hurdles to making a vaccine against a Coronavirus.”
Until now! Yay! The vaccines are 95% effective.

Me cheering them on, since I definitely don’t know how to make vaccines.

25:25 “There’s no independently published animal studies.”
Besides the fact that this technology has been studied on animals for 30 years now, this just isn’t the way we conduct clinical trials. Maybe Dr. Gold is hedging here with the term “independently” and wants a particular standard of non-involvement of the vaccine designers with animal studies, but if so that’s special pleading; it’s common for vaccine manufacturers to co-author academic papers with independent labs, and both contribute different information to the paper; after all, they have to send some of the vaccine before it can be tested on the animals at the lab.

So if Dr. Gold is really just saying there needs to be data from animal studies about the safety of these new mRNA vaccines, well great news:

That was just a search for mRNA COVID-19 vaccine mice, and there’s pages and pages of it.

There is substantial, published data on animal studies both for mRNA vaccines in general and for the COVID-19 vaccines specifically. Here’s an AP Fact Check on the topic if you want to learn more.

Dr. Gold goes on to mischaracterize the status of animal studies further, at 25:45 saying “the animals often die in the end, and unless we know that we don’t know if it’s safe to give to humans.” So in 20 seconds we have gone from not having full access to the results of independently published animal studies, which isn’t true, to not knowing whether the animals died. That’s a pretty big jump. (There’s also a ‘Schrödinger’s Cat’ joke in there somewhere but the internet has too many of those as it is).

25:59 Antibody-Dependent Enhancement (ADE)
Immune enhancement is a very real concerned, and one that has been hotly debated within research circles since the beginning of the pandemic, especially in regards to severe COVID-19 cases and the potential role of vaccines. Here’s an article from way back in May 2020 (what is that, like 8 years ago now?) about this exact issue. The specific proteins chosen for the mRNA vaccines were chosen carefully and specifically to avoid this problem, and moreover, this is exactly why we do animal studies and clinical trials.

The Moderna and Pfizer trials were simply huge, with ten times the number of people participating than is typical in a vaccine trial; and no evidence of Antibody-Dependent Enhancement was found. The Nerdy Girls over at Dear Pandemic have a short but great social media update on it from just a couple of weeks ago:

27:21 “Stop Medical Discrimination .Org”
I had to do a double take and rewind (I’m old) the youtube video at this point, because I couldn’t believe what Dr. Gold just said. Do we have some common ground? Health equity, medical discrimination, and American medicine’s history of unequal treatment of people of color, ethnic minorities, and women is a huge issue for me, and my clinic is involved in this work every day. If Dr. Gold has a website devoted to stopping medical discrimination, I will absolutely sign-up, even if I disagree with her about pretty much everything else.

I went to the website. It’s an America’s Frontline Doctor’s Petition to stop ‘forced experimental vaccination’, which is a thing that is not happening (so I guess it worked?).

Justin, could you e-mail them about getting that logo centered over the text? Thanks.

This is pretty gross, to be honest. Discrimination in medicine is a real thing and one of the biggest obstacles both in patients receiving equitable care and in physicians building mutual trust. It is experienced every day by Black Americans, Native Americans, Hispanic and Latino Americans, people who are LGTBQ+, those who struggle with obesity, the disabled, the deaf, the blind, women… Really anybody who isn’t like me; an able-bodied, fairly young, straight white English-speaking male, which we have decided is the standard for “normal” to the great detriment of everyone else (not to mention the peril of our souls). It also applies to those who are discriminated against for work, housing, etc. because of their medical conditions. Personally I’m not ok with America’s Frontline Doctors co-opting either.

Looking ahead, we are going to talk about this later in the video as it relates to Dr. Gold’s complete misunderstanding of racial healthcare disparities (but honestly, I’m glad she’s even mentioning it, even if she gets a lot of the concepts completely backwards). My next blog post will focus heavily on the history of American medicine’s research abuse towards African Americans specifically, and the work Black scientists, physicians, and community leaders have done to ensure the vaccines are safe, and the work they are doing to ensure their communities have equal access to vaccine-mediated protection against the virus. That will be later this week, but in the meantime… You should go read Harriet Washington’s Medical Apartheid, and listen to her 6 minute NPR interview about the vaccines and the problem of how Black Americans can trust new medical technology: Race and the Roots of Vaccine Skepticism.

27:33 “Some of the other things you’ve seen in the news.”
Here Dr. Gold is using “in the news” to mean “on Facebook”, but that’s fine. Kudos to her for skipping over some of these that have been disproven, though I suppose she felt she needed to mention them for anyone in her audience who had seen this misinformation already. For what it’s worth, here’s my analysis of the COVID-19 Vaccine Bell’s Palsy video that came out a few weeks ago.

28:10 – 30:04 “Has anybody heard of potential fertility problems with this vaccine?”
Based on her response I assume that many hands were raised, which isn’t surprising; this has been popular misinformation for months now. I’ve written about it before and since Dr. Gold isn’t actually adding anything new, we’ll move on. The COVID-19 vaccines do not cause female infertility; please feel free to read about it on my Vaccine Q&A post linked above, or any number of fact-checking websites.

30:09 “We simply don’t know.”
“Well you can’t possibly know” is the last redoubt of the lazy skeptic. No scientist would ever claim 100% certainty about what might happen, and the lazy skeptic will take that tiny element of doubt, which is really just a protection against hubris, and expand it until there is enough space for any debunked objection or pet theory they want to store there. There are multiple lines of evidence against the possibility of the new vaccines causing infertility, as I examine carefully in the above link, including many examples of women who have become pregnant after completing one or both doses of the vaccine despite being on birth control to prevent pregnancy. Moreover, there is not a plausible theoretical mechanism by which they would cause infertility. Making irrational, unproven claims and then when they are disproven saying “well we can’t know for sure!” isn’t science; it’s fear-mongering.


Part 3: COVID-19 Vaccines and Racial Healthcare Disparities

I don’t always get to watch these videos all the way through before beginning a response, and especially with the minute-by-minute format I tend to write piecemeal as we go through the video (listen, pause, think, read, think, type, repeat). After being so offended that Dr. Gold would call her anti-vaccine petition website “Stop Medical Discrimination,” I was surprised- and not necessarily unpleasantly surprised- to see her spend so much time on the issue of race and COVID-19 vaccines. In fact, with the exception of her group’s recommendations about getting vaccinated (spoiler: they prohibit or strongly discourage it for almost anyone), the rest of the video focuses on this issue. It’s 11:52 PM on Sunday night, so we won’t make it to the recommendations; if you’ve read this far and you still trust Dr. Gold’s analysis, there is nothing I can say at this point to convince you not to follow her advice; I just hope you’ll follow more reliable medical experts instead, and at least talk about it with your doctor.

I am also anxious to get to my next blog post, which coincidentally or not, is 100% about race and the COVID-19 vaccines, and specifically the question of how Black Americans could trust these vaccines in light of America’s long history of medical research abuse. The main point of that upcoming post is to share resources directly from Black scientists, physicians, researchers, and healthcare professionals; but I’m also going to be taking a look at the history of medical research abuse towards African Americans and at the current pandemic’s disproportional impact on Black communities. In that sense, while the post has nothing to do with Dr. Gold, some portions of it could be seen as a response to her comments in during this section of the video.

For now, I want to say three things to introduce that article, which I hope you’ll join me for later this week, and to conclude this minute-by-minute analysis of as much of Dr. Gold’s hour long talk as I could make it through.

First, I am very, very glad that Dr. Gold is talking about this.
There are a lot of Dr. Gold’s comments I disagree with, and certain points where her analysis and conclusions are essentially backwards. But the fact that she is talking about it is a good thing. The history of medical abuse and research exploitation of Black Americans is one that is too often waved off as one or two isolated examples (Tuskegee) or ignored completely, especially by white doctors. Meanwhile, this history is part of a common experience and shared cultural narrative among Black Americans, and the disconnect between it being known by the group who has experienced it and unknown or unmentioned by the group that perpetuated it can create a tension that is absolutely deadly to the trust the doctor-patient relationship is built on. Dr. Gold is a great example here, in that she acknowledges some part of that history, and in front of a predominantly white audience.

Now, that doesn’t mean I think Dr. Gold’s talk is useful or good; her information on COVID-19 and the vaccines is all wrong, and so her interpretation of important race equity measures in vaccine distribution is interpreted as a racist attack on people of color instead of an attempt to mitigate already existing injustices. She happens to have it exactly backwards; but if she really believes everything she has said in this video, and I think she believes an awful lot of it, then it’s likely she believes her own analysis here, too. Because it isn’t accurate, the net effect of this part of her talk, were it heeded, would be to worsen the already severely inequitable impact of COVID-19 on communities of color, and obviously using that history to that end is incredibly problematic. But at the very least, talking more about that history is a good thing in itself.

Second, Dr. Gold is absolutely underselling the history of harm done to Black Americans by medical science.
Dr. Gold mentions a few specific examples of vaccine reactions that were worse in African Americans, and (I actually can’t remember now if she does or not) mentions a few other examples of racially motivated medical harm. But the true history spans 400 years and is far worse than anything I ever expected, even reading and learning about a few of the most notorious examples in college and medical school. We will look into this in more detail in the upcoming post, but I strongly encourage you to read Harriet Washington’s book, Medical Apartheid.

Third, Dr. Gold is utterly confused on the concept of racial healthcare disparities.
Dr. Gold spends a lot of time arguing that Black communities have not really been more severely effected by the pandemic. Of course, the pandemic is having a more severe impact on Black communities, and Hispanic/Latino communities, compared to their white neighbors, so this feels an awful lot like a magic trick; Dr. Gold is going to make the disparities disappear before our eyes. And the two methods she has chosen? First, to explain away the worse impact of COVID-19 not by race but by economic and social circumstances that place people at disadvantages in terms of health outcomes, and then controlling for all of these, to show that race disappears as a factor. And second, to point to Africa and say that ‘if the virus isn’t killing people at a higher rate in Africa, it must not affect Black people worse.’

It’s really hard to tell if Dr. Gold is in earnest here, but if she is then she really believes that when we say “Black Americans have been hit harder by COVID-19 than white Americans,” we are saying “COVID-19 makes you sicker if you have more melanin”; a position held by exactly zero doctors, epidemiologists, and public health experts.

When we look at the shocking statistics, like the fact that the death rate in any given age range for Black Americans is equivalent to the death rate in White Americans 10 years older, what we are really looking at is the ongoing legacy of food desserts, inequitable access to wealth, intentional destruction of Black communities, mass incarceration, redlining and planned poverty, barriers to medical access, and every other atrocity that makes up 400 years of systemic oppression.

Brookings: Race gaps in COVID-19 deaths are even bigger than they appear

Sure, let’s say for the sake of argument that if you controlled for every social determinant of health, every area in which Black Americans have experienced discrimination and continue to today, the gap in COVID-19 between Black and white Americans would completely disappear (it leaves out discrimination within healthcare, but again… for the sake of argument). Why would that matter? Does a statistical linear regression that eliminates the results of oppression actually alleviate oppression, or just make it more palatable because we can rationalize away healthcare disparities without the discomfort of actually examining root causes?

The fact that there is no genetic factor that makes COVID-19 more dangerous for Black people is exactly the point; it’s the injustices that Black Americans already experience, especially regarding healthcare access, that make the pandemic more dangerous. That is why efforts have to made to ensure Black Americans have equal access to the COVID-19 vaccines, because they are the best tool we have for mitigating the risk of the virus; and it is exactly why Black leaders like the Black Coalition Against COVID-19 are coming together to provide good, reliable information and to dispel COVID-19 myths, so that Black Americans can choose whether or not to get vaccinated with confidence, and so that they will have increased resilience against medical disinformation like Dr. Gold’s video.

I hope you’ll join me to talk more about this later on this week. In the meantime, please check-out the Black Coalition Against COVID-19 and the other resources I’ve linked to above.

Black Coalition Against COVID-19

COVID-19 and Bell’s Palsy: I wish she was my patient.

When a friend sends me a video about a vaccine reaction and the next day multiple patients mention the same video to me in clinic, it’s probably time to watch it, and write about it. The video I’ve linked to below is of a registered nurse named Khalilah Mitchell who lives in Nashville Tennessee, who warns about developing Bell’s Palsy, paralysis of one side of her face, after receiving a COVID-19 vaccination. It is impossible to watch the video without empathizing with her, and I encourage you to watch it if you possibly can; I’ve supplied the link below, assuming it’s still up.

Video: RN Took Vaccine: This is What Happened

Instead of going through it minute-by-minute like we’ve done so often in the past (it is very short, at just one minute and twelve seconds), I want us to dissect a few different aspects of this.

Contents:

Healthy Incredulity
Bell’s Palsy: Medical Facts
Bell’s Palsy: Why I Wish She Were My Patient
Healthcare as War on Black Bodies


Healthy Incredulity

I want to start by stating that I believe this person’s story, for reasons we will get to in a moment. I think that when we develop the disposition to refuse to believe people’s stories about themselves and their experiences we place ourselves in grave peril. This is one of the common and insidious effects of the disinformation campaigns (both medical and not) that we have seen escalated over this past year; whenever someone hear’s something that doesn’t fit into their chosen narrative, they can simply say “but how do we even know if that actually happened?” Certainly, when someone (I won’t name names) consistently proves themselves to be a source of falsehood, their word becomes worthless; but to automatically treat a stranger that way, especially a stranger who is clearly hurting, is to shut ourselves off from compassion and reason in the name of protecting our own biases.

This individual is clearly distraught and deserves our empathy. But there is a balance and a tension here, because the 340,000 people who have died from COVID-19 in the US, and the 1.8 million people who have died from it around the globe, and their families and friends and communities, also deserve our empathy; and so do the many more who are still at risk. We can love both, and that may mean accepting someone’s narrative about themselves and their experiences without agreeing with their scientific conclusions. And that’s ok.

And so while I believe this person’s experience, I would be remiss if we did not start with a very brief survey of what we do and don’t know to be true from this video, for the sake of encountering this sort of viral information with our eyes fully open.

  1. We know this woman has Bell’s Palsy, or at least has visible symptoms consistent with that diagnosis.
  2. We know she is an African American woman, a group who among all demographics in the US probably has the most reason to be cautious and skeptical towards the medical field.
  3. She identifies herself as Khalilah Mitchell, a Registered Nurse in Nashville, TN
    • The Tennessee nursing board does not have any record of a registered nurse by that name.
  4. She reports that she developed Bell’s Palsy shortly after receiving the COVID-19 vaccine.
    • We do not have evidence that she received the COVID-19 vaccine.

Let’s talk about that 3rd bit, which has been homed in on by multiple fact-checking sites. There are multiple reasons Khalilah Mitchell might not be listed on the Tennessee nursing board’s online records:

  • She may be a recent graduate or have recently received her license in that state; we don’t know how long it takes for those licenses to be searchable online.
  • We are in the middle of a pandemic; she may be a nurse licensed in another state who has special permission or an emergency/temporary license to do travel nursing in Nashville.
  • She only states in the video that she is “in Nashville Tennessee.” She may well be licensed in and work in another state while living in (or even visiting) Nashville. This is not uncommon.
  • She may go by Khalilah but actually have a different legal first name; Khalilah may be a middle name or a nickname.
  • She may be Khalilah Mitchell but be registered under a different last name because of a recent marriage, divorce, etc; changing your name on your nursing license is a beast of a process, as my wife can tell you first hand.
  • She may be using an assumed name or placing herself in a different city and state, or both, to protect herself from reprisals in case this video goes viral (which it has).
  • She may be lying.

Only one of those reasons, all of which are feasible, negates her story; only one causes us to mistrust the only unprovable/non-falsifiable aspect of her story, that she did indeed receive the COVID-19 vaccine prior to developing her symptoms.

Sadly, hiding among the many people with legitimate fears and uncertainties about healthcare in general and vaccines in particular, there are dishonest people who are not above creating misleading and blatantly false information to deceive others. If this person were a known producer of anti-vaccine propaganda, disbelieving her entire story would be warranted; but I have no reason to believe that’s true, and thus have no reason to disbelieve her story, as some have done, merely because certain aspects of it cannot be verified.

So I believe her story. However, because there have been and will continue to be elaborate, malicious attempts to deceive the public about these COVID-19 vaccines, I believe we are justified in maintaining a healthy degree of incredulity each and every time we encounter one of these types of videos; the intellectually honest and important work of discerning whether the information presented is true in no way negates or cheapens our compassion for the speaker.


Bell’s Palsy: Medical Facts

I want to talk about the clinical side of medicine, and the human side of medicine. In reality we can never separate them, but we can compartmentalize them for a few moments for the sake of discussion.

Bell’s Palsy is a temporary paralysis of the Facial Nerve, the seventh cranial nerve which controls the muscles of the face. This paralysis occurs without warning, usually gets worse over 2-3 days, and then starts to improve after about 2 weeks. Usually it is entirely improved by 6 months and does not cause long lasting symptoms; but sometimes it does, and the extent of damage to the nerve likely plays a role in the symptoms lasting longer. The cause is unknown. It’s an area researchers have studied for years. A leading theory is that, like shingles, it is caused by a reactivation of a herpesvirus that lies dormant within your nerves. In that case it can be triggered by any compromise of the immune system, but also by physiologic stressors; it has been associated with diabetes, high blood pressure, pregnancy, acute viral infections, and vaccines, all of which tax the immune system (the latter two temporarily). Another theory says it is the immune system itself, in the act of fighting the virus, that causes ‘friendly fire’ damage to the nerve, and this would also explain why it is not just associated with herpesviruses but with other viruses like flu, hand-foot-and-mouth, common colds, and even COVID-19 infection itself. The immune system is also activated by vaccines (that’s how they work; they teach your immune system how to fight new viruses and bacteria it has never seen before), and so also have the theoretical potential to cause Bell’s Palsy, though careful studies have not supported an actual link between vaccines and this condition. But these are still just theories, and we don’t actually know. I treated a patient last week whose Bell’s Palsy, as far as we can tell, occurred seemingly at random.

So, do the COVID-19 vaccines cause Bell’s Palsy? It’s a difficult question to answer. In the vaccine trials, the rate of Bell’s Palsy was incredibly low: 4 in the Pfizer trial and 3 in the Moderna trial; 7 cases out of over 70,000 participants. That’s less than half the normal rate of Bell’s Palsy in the general population, which is about 35 cases per 100,000 people. The rate was higher in the vaccine group than in the placebo group, though the numbers are far too small to draw definite conclusions.

If I were to sum up the evidence for my patient or my family member, I would tell them this; getting the COVID-19 vaccine might carry a tiny increased risk of developing Bell’s Palsy compared to not getting the vaccine; but the risk is still about the same overall as it would be just going about your every day life.

Maybe that feels like a paradoxical answer, but truth is often like that. About 40,000 Americans have had Bell’s Palsy this year; very, very few of them have had the COVID-19 vaccine, but those that did may blame it on the vaccine. Those who didn’t may blame it on something else; another illness, their flu shot, stress. They may be right or they may not be, but until we understand the condition better there is simply no way to perfectly avoid it, and it is so rare and typically so benign a condition in the long run that basing our medical decision making on it is unreasonable, both as physicians and as patients (and please remember, I am both, just like every other doctor you know). If you get the COVID-19 vaccine, you are extremely unlikely to develop Bell’s Palsy; no more or less likely than you are to develop it in the coming year anyway. What you are much, much less likely to develop is a severe or fatal case of COVID-19.


Bell’s Palsy: Why I Wish She Were My Patient

Reading that last section, you may think I’m going to say “I wish she were my patient because I could help her understand that her Bell’s Palsy probably wasn’t from the COVID-19 vaccine.” Um, no. My experience has taught me that, for better or for worse, once someone has formed a firm mental association between an event or intervention and deeply distressing symptoms, that association is incredibly difficult to break; even when there is absolutely no plausible link between the two, which is not the case here. Not to digress too far, but I commonly try to break those associations in exactly two situations: first, when my patient has linked their negative experience (or that of a loved one or friend) to a medication or treatment that is actually going to be life-saving for them, or relieve a great deal of their suffering, and there is actually no causal link between them. And second, when the patient has incorrectly linked a negative medical outcome to some perceived failure of theirs. I have at least one or two conversations a month with women who have had miscarriages and have definitely assigned the blame for that tragedy to themselves for some action or omission that couldn’t have caused it; some bump they went over on the road a few days before, a drink of alcohol or a cigarette they smoked before they knew they were pregnant, getting their nails done or taking a dose of an over the counter cold medicine. We spend a long time talking about the causes of miscarriage, because if possible I want to help them let go of that shame and self-blame they’ve have been carrying, and will carry, their entire lives. Those are the circumstances where it is worth it to me to really try to convince my patient that the medical facts really do override their perceived association. With this woman in the video, if she were my patient and we developed a trusting relationship over many years, maybe at some point we would be able to have a frank and honest discussion, looking back, about whether or not that Bell’s Palsy was really caused by the COVID-19 vaccine, and help her loosen that association; but telling someone who is suffering “you are probably wrong about why you are suffering!” is not just an exercise in futility, but a failure in empathy as well.

No, the reasons I wish she were my patient are twofold; first, because I treat Bell’s Palsy all the time and there really are some things you can do to give the patient the best possible chance at recovery. There’s evidence for early steroids and anti-virals, and there are supportive care measures, like synthetic tear eye-drops, to protect from some of the potential long-term complications. We also talk about adjunctive treatments like facial massage, stretching, and facial muscle exercises that have never been proven but are not likely to do any harm either, and will help the patient feel they are an active participant in their treatment (I am always explicit about that last goal; we are not trying to ‘trick’ the patient into thinking they are helping to make them feel better). I print handouts for my patients all the time to help guide their own reading and research at home, and have one I like for Bell’s Palsy because it carefully explains the possible causes, the symptoms, and the prognosis. Medically, Bell’s Palsy is somewhat satisfying to treat because it usually does get better, and in general walking through an illness with someone as it improves is a lot less of an emotional burden for me than sitting with someone in the grief and pain of an illness that isn’t going to improve, which is vital work I wouldn’t give up, but is laden with moral injury.

And second, I wish I were her doctor because in this video she is clearly emotionally distraught. That is the aspect of this illness that the fact checking sources have seemed to ignore; the fact that this illness is incredibly distressing, even though it does have a good prognosis. I have read article after article in the few days since this video came out explaining that 1. the vaccine didn’t necessarily cause the Bell’s Palsy, and 2. it doesn’t matter because it’s a benign condition. But watch the video; it definitely matters to her. The embarrassment of having half of your face paralyzed, but people thinking you’ve had a stroke when you haven’t, of feeling self conscious everywhere you go; a condition can be benign medically but not benign psychologically, socially, or emotionally. When I visit with a patient for a condition like this, our time together is spent as much in counseling as it is in devising a medical plan. We sit in that sorrow, even as we provide hope that it will be short-lived. We offer reassurance but we know that our patients are not thinking about the low rate of long-term complications when they look in the mirror and see a face they don’t recognize. It’s hard. Maybe Khalilah Mitchell would still have been this distraught after our visit for her Bell’s Palsy, and maybe she would have felt some solace and reassurance; I can’t say. But as a physician, when I watch someone who is absolutely grieving over their medical condition, my heart goes out to them and I wish we had the opportunity to just sit down and talk about it.

These vaccines are the best hope we have of ending the pandemic compassionately, with less loss of life. I believe in them. They are safe, and your chances of developing a significant reaction- including Bell’s Palsy- is incredibly low. I absolutely disagree with Nurse Mitchell that these vaccines are “the worst thing ever”. She is very understandably thinking about her own symptoms and not about the millions of lives they will save. Yes, as a medical professional there is a tension between our own distress and the need to think of others before spreading information that can cause harm, as this video certainly will; as a Nurse, she may indeed be failing in her calling to care for the vulnerable by disseminating claims about the vaccine based only on her own negative experience and not on solid scientific facts. But that’s her right as a patient, and the reality is that most of us will put our own anecdotal experiences above facts when push comes to shove; if this video is sincere, then she sincerely believes she is doing the right thing by trying to protect others from what she has suffered, as ungrounded in the medical realities as that concern is.

As a human being created in the Image of God, Khalilah Mitchell deserves our empathy and compassion for what she is going through first and foremost, even as we work to undo the harm this video is going to cause.


Healthcare as War on Black Bodies

There is one last, vitally important issue that comes up in this video, and if you are privileged to have a long history of the medical field treating people who look like you extremely well, as I am, it may be so subtle that you miss it entirely. Towards the end of this short video, after discussing her personal distress and her opinion that the vaccines are terrible, she closes with this heartfelt appeal,

“Please, America, They do not care about us. Do not take this vaccination.”

I will not claim to speak for her, or to make assumptions about who she includes in “they” (big pharma? medicine? doctors? She states she is a registered nurse herself, so I do not think she can mean the entire medical field), or who she includes in “us.” Certainly she addresses all Americans, but we would be naive to think that her message of “they do not care about us” would resonate equally with everyone. People who have historically experienced and currently experience inequitable medical treatment, poorer access to high quality care and lifesaving treatments, systemic discrimination, and even therapeutic, malicious medical experimentation are going to understand this video in the context of a shared cultural narrative that already teaches that you cannot trust the medical field to have your best interest at heart. This includes women, LGTBQ+ persons, the disabled, those who are obese, non-native English speakers, Hispanics, Native Americans, and at least one group Nurse Mitchell seemingly belongs to herself, African Americans. If you need evidence of this, the instagram tag on this video, @DTR360BOOKS_, is connected to an online bookstore that specializes in works about racial justice, black empowerment, and racial conciliation. If anyone, and particularly any white people, are asking why this one minute video has been shared hundreds of thousands of times on social media, read on.

Before you click over to the ‘About the Author’ page, I’ll let the cat out of the bag; I am a white, able-bodied, English speaking male (I am not neurotypical [ADHD], but I know few doctors who actually are). Healthcare justice, especially in the area of race, is something I was able to casually ignore for a long time because it simply didn’t affect me. But it affects my patients every day (and because of that it certainly makes my life harder too, though obviously to a lesser degree), and in the last few years it’s an area I’ve come to learn more and more about. Suffice to say, I absolutely do not feel adequate to the task of writing about this topic; but I am going to try anyway.

The long history of medical experimentation and abuse of African Americans, of which the notorious Tuskegee Syphilis Study is only a link in the chain, is documented in historian Harriet Washington’s book Medical Apartheid, and elsewhere. If you have time to read this long and rambling blog post you definitely have 7 minutes to listen to her explain the connection between this long history (the word “history” does not here imply that it is over, as the recent COVID-19 death of one of my Black Physician sisters tragically illustrates) and the skepticism, doubt, and fear about the COVID-19 vaccines that exist in communities of color.

Race And The Roots Of Vaccine Skepticism

Of all the wisdom she shares in this brief interview (you should really read her books), this is the one that I think is closest to our purpose:

“I think this is a good thing to do because I think this vaccine looks as if it’s going to be safe, efficacious – just what we need. So anything that’s done in terms of encouraging African Americans to benefit from it, too, I think is a good step. However, it’s not a substitute for reforming the health care system. If we don’t reform the system, if we don’t make real, large steps toward addressing the inequities that cultivate distrust, then we’re going to have to do this every time we have a new health initiative. That’s a complete waste.”

Because of the systemic healthcare discrimination and poorer access that Black Americans still suffer from today, the COVID-19 pandemic has specifically devastated those communities, causing a disproportional number of deaths and severe illnesses greater than in any racial demographic besides hispanic/latino persons, and far greater than the impact on white communities. It is not hyperbole to say that African American communities are among those that need very high rates of COVID-19 vaccination the most to stem the tide of this pandemic and prevent further loss of life. And yet, the long history of broken trust on the part of the medical field is now paying dividends, and many in the communities that need the vaccine the most are reasonably mistrustful of a great deal of medical interventions; and especially of anything that seems new or experimental.

There are a great number of reasons to trust the safety and efficacy of the COVID-19 vaccines; they are outside the scope of this post, but I am addressing this piecemeal in my COVID-19 Vaccine Q&A. Just as Nurse Mitchel believes based on her very distressing personal experience that it is good to encourage people to avoid the vaccine, I believe based on the overwhelming scientific data that it is good to encourage my patients, friends, and family to get vaccinated. But Harriet Washington’s work was instrumental in my deciding to get the vaccine myself, which I did last week.

I am low risk, and would much rather have reserved my dose for one of my patients who needs the vaccine more than I do. I’ve written about this tension at length, and the great discomfort I have in receiving any medical treatment not available to all of my patients. But ultimately it was this quote from Medical Apartheid that made me decide to get vaccinated:

“Western physicians have adhered to a long and noble tradition of following animal studies with limited self-experimentation by researchers. This tradition may not always have been prudent, but by testing substances or procedures on themselves before experimenting with appreciable numbers of human subjects, doctors symbolically conveyed their belief that the measures were not inordinately harmful and also signaled a researcher’s willingness to share the risks as well as the glory of discovery.”

I am not a vaccine researcher, and there is no glory at all for me in people getting these vaccines. But they will protect my patients from COVID-19, and I deeply believe that as a medical field our solidarity with our patients, especially those who have been historically and actively marginalized by the medical industry, is an essential component of rebuilding trust. That means not only saying something is safe and encouraging our patients to have it done, but whenever possible taking on the potential risks within our own bodies alongside, and when necessary ahead of, our patients.

Yesterday two patients asked me about the COVID-19 vaccines and about this video specifically, both of them African American. In each case we talked about Bell’s Palsy, the vaccine safety trial data, the way vaccines work, and the history of medical abuse of Black folks in America; a condensed version of the contents of this blog post. We also talked about my experiences getting the vaccine, and my definite conviction that I would never ask my patients to consider a medical intervention I wouldn’t be willing to have done for myself or my family. Both left considering the vaccine, and at least one had definite plans to get it as soon as it was available. I am thankful, because both had risk factors for COVID-19 independent of the risk factor of belonging to a group marginalized by the healthcare sector.

This viral video is going to convince a lot of people not to get vaccinated. It shouldn’t, as we’ve discussed, but it will. My getting vaccinated will convince only a very few to get vaccinated themselves. But if I can show the band-aid on my arm to my patient and look them in the eye and tell them I believe so strongly that these vaccines can help protect our communities that I’ve had it done myself, maybe it will help a few. I can’t look you in the eye through this blog, but I hope you hear my heart, and I hope you decide to get the vaccine yourself to protect those you love and your own community, just as I’ve done.

COVID-19 Vaccine Questions & Answers

Contents:

How do these vaccines work? 12/24/2020
Will the vaccines have any lasting effect on my body? 12/26/2020
What about infertility? 12/26/2020
Aren’t the vaccine ingredients toxic? 12/29/2020
If I get the vaccine, can I still transmit/spread the virus? 1/7/2021

Other COVID-19 vaccine posts and links


Intro: Talking about vaccines as a Family Medicine doctor

As a Family Medicine Physician, helping patients navigate uncertainty and doubt around vaccines has been a part of my day-to-day job since long before the COVID-19 pandemic. I have always tried to approach those conversations with patience and understanding (not that I’ve succeeded each and every time), knowing that behind their questions and even suspicion there is, without exception, a deep desire to do what is best and safest for themselves and their families. I get it; vaccines can feel scary. They are pretty mysterious for most people, and there is so much controversy over them that our intuition tells us surely some of it must be true (even though the people who creating it are often intentionally deceitful). I am a father of 4 myself and understand how strange and frightening it can feel to have your child undergo any medical procedure; but unlike an infusion of antibiotics or a dose of tylenol, or the sedated lumbar spine MRI my daughter needed for tethered cord syndrome when she was 1 year old, vaccines are given to children who are healthy to prevent future illness; it makes the decision harder, because the reason for the treatment isn’t readily apparent or at the forefront of our minds.

Vaccines are also one of the single most important innovations of modern medicine, and have saved millions of adults and children from dying of some of the worst and most painful infectious diseases that afflict humanity.

That’s why it’s incredibly important to me that my patients have the time to ask their questions and why I believe they deserve careful, sincere, and thorough explanations. So when I think about all of the medical misinformation that is out there right now around the COVID-19 vaccines and how we can possibly alleviate those fears, I start by imagining a patient sitting across from me in my clinic exam room with doubts, uncertainty, or even trepidation about these new and rapidly developed vaccines, and try to write out how I would try to answer their questions.


𝐇𝐨𝐰 𝐝𝐨 𝐭𝐡𝐞𝐬𝐞 𝐯𝐚𝐜𝐜𝐢𝐧𝐞𝐬 𝐰𝐨𝐫𝐤?

Updated 12/24/2020

When discussing vaccines with my patients, I always, always start with a brief discussion of how they work. It’s not uncommon to hear someone say “I think it’s better to rely on my own immune system” when discussing vaccine preventable illnesses. We’ll talk about this in more detail later on, but my first response is usually to help my patients understand that that is exactly how vaccines work; by relying on your own immune system.

Our immune system is designed with two strategies for fighting infections. The first is non-specific but immediate; in addition to our innate protective barriers like skin, hair, and mucous, we have cells like macrophages, mast cells, and natural killer cells that are able to detect and attack any foreign invader that the body recognizes as not being part of itself. This is a good system and prevents you from getting sick all the time; without it, we would be constantly fighting illness and infection from normal everyday exposures, just as many do who have compromised immune systems.

But even more powerful is our adaptive immunity, which is directed specifically against infections our body recognizes and has dealt with before. This is an incredibly robust system of B and T lymphocytes and antibodies that recognize the invading pathogens and kill them with a higher degree of efficiency and precision. The only problem with it is that it takes time to kick into gear the first time your body is exposed to a new infection; and then it’s a race to see whether it can become active enough, fast enough to prevent an illness from becoming severe. On subsequent exposures, that response is much, much more rapid; so much so that you usually don’t even know you’ve been re-infected with that bacteria or virus because you don’t get sick.

The principle behind vaccines is simple; what if we could safely teach the adaptive (specific) immune system to recognize the deadliest infectious diseases, so when someone is exposed the first time they can mount that powerful, targeted immune response right away and not even get sick?

And that’s exactly what these COVID-19 vaccines are designed to do, just like all of the vaccines before them; they give the body the information it needs to mount a robust immune response with the adaptive immune system as well as the innate immune system, without any possibility of causing an infection in the process. So when someone asks, “wouldn’t it be better to rely on our own immune system?” my answer is, “Yes, absolutely! And vaccines allow us to rely on our entire immune system, not just the weaker half, without even getting sick.”

We will talk about the differences between how traditional vaccines and the mRNA vaccines accomplish this later (and whether or not they re-write your DNA). For now I’ll just say that the new vaccines are even closer to naturally acquired immunity than traditional vaccines, because they trigger our immune system almost exactly like the viruses themselves do.


Will the vaccines have any lasting effect on my body?

Updated 12/26/2020

Hopefully! That’s sort of the idea. While the messenger RNA only survives for a few minutes before degrading, the antibodies that are produced will circulate for months, and some of the other cells of the adaptive immune system, specifically the antibody-producing plasma cells, will hopefully migrate to the bone marrow and lie dormant for decades, which is how vaccines given in childhood continue to provide protection many years later. This is true of the annual flu vaccine too, by the way; the issue isn’t that those vaccines don’t provide lasting immunity, but that influenza is a rapidly mutating virus and different strains are more common every flu season. So your flu shot from 1997 or 2008 is still providing you with protection… But only against the flu strains that were chosen for the vaccine in 1997 and 2008. They’ve even done studies that showed people who survived the Spanish Flu Pandemic of 1918 could still produce an antibody response 100 years later! Coronaviruses mutate much more slowly than the flu, but it is too early to know whether SARS-CoV-2 will mutate enough or in the right way to require additional, regular vaccinations. If we can judge by the SARS and MERS epidemics of 2002 and 2012, it seems unlikely.

As far as other changes to our bodies, thankfully there is no plausible mechanism by which the COVID-19 vaccines could cause other chronic changes than the desired immune response. The mRNA only codes for a few specific proteins and cannot produce an active virus, and the fats, sugar and salts in the vaccines do little else than package the mRNA and help it get into the cell.

What about Infertility?

There has been misinformation circulating online about the vaccines causing female infertility, but these are baseless. The original claim can be traced back to Michael Yeadon, a former Pfizer researcher and COVID-19 denier who has also posted videos claiming that the pandemic really ended in late Spring, at least in the UK, because most of the population was already immune due to having antibodies to other coronaviruses, which cause the common cold (as of today there have been over 70,000 deaths in the UK from COVID-19). This is an extremely ironic idea in light of his claims about the vaccine causing infertility, as we shall see shortly. He has not worked for Pfizer since 2011, and calling him the “Head of Pfizer Research” is just as deceptive as the rest of the headline and article.

The vaccine does not contain a spike protein called Syncytin-1, at all; the article above is simply lying at that point. The actual theory claims that the COVID-19 spike protein the vaccines code for shares similar amino acid sequences with a human protein, Syncytin-1, which is important in placental development. They reason that antibodies trained to attack COVID-19 would also attack Syncytin-1, causing infertility. This is illogical and scientifically invalid for a few reasons. 

First, we have already had 80 million cases of COVID-19 worldwide and there has been no evidence of infertility as a side effect; yet the body of any infected person is going to produce antibodies against multiple COVID-19 proteins, including the spike protein in question. If the antibodies we develop against the spike protein from having the virus don’t attack Syncytin-1, there is no logical reason to believe vaccine-induced antibodies would either.

Second, we have evidence from the COVID-19 vaccine trials themselves that pregnancy occurs at similar rates between those vaccinated and those not vaccinated. The vaccine trials did not include pregnant women or women who intended to become pregnant, and all women of child-bearing age that participated had a negative pregnancy test before their first dose and committed to using a method of birth control throughout the study. Thirty-nine women became pregnant anyway; twenty-three in the Pfizer trial and sixteen in the Moderna trial, and the rate of unintended pregnancy in those who received the vaccine was about the same as in the placebo group. Those numbers are too small to draw serious conclusions, but the point is that we already have examples of women who became pregnant after receiving the vaccine, even though they were actively preventing pregnancy; in the coming months as more and more people receive the vaccines, we will have many more examples, and because this misinformation has been popular there are already studies planned to track the pregnancy rate following vaccination.

Third, the number of amino acids in the shared sequence is actually tiny; a segment of 5 amino acids, with only the first two and the last two being shared. Syncytin-1 has a full sequence of 538 amino acids, and the COVID-19 spike protein itself is 1,273 amino acids long. We have an analogy in human disease; one explanation for rheumatic heart disease following streptococcal infection is that certain proteins in the Group A strep bacteria share similar amino acid sequences with myosin, a protein found in heart muscle, allowing antibodies against the bacteria to cross-react with heart tissue. However, in that case there are not only much longer sequences of shared amino acids, but multiple sequences that repeat multiple times each. The section of shared amino acids in the case of Syncytin-1 and COVID-19 antibodies just isn’t significant, and you will find many viruses and bacteria in nature that share such similarities with a great many proteins in humans.

Finally, SARS-CoV-2 is not the only coronavirus in existence; not by a long shot. Coronaviruses are one of the main groups of viruses that cause the common cold, and you and I have both had many coronavirus infections throughout our lives. You still have antibodies to those coronaviruses, as Dr. Yeadon points out in his other videos. Every single coronavirus has spike proteins (that is what gives them their name; they form a halo, or corona, around the virus when you look at it through an electron microscope), and all of those spike proteins share as much or more similarity to Syncytin-1 as the COVID-19 spike protein, because they play similar roles in viral replication to what Syncytin-1 does in placental development (they are fusion proteins). So you have already developed antibodies against coronavirus spike proteins all throughout your life, maybe even every single year, just like everyone around you; and yet this has never been identified as a contributing factor in human infertility. 

So yes, the vaccine will have a lasting impact on your body, assuming you respond well like 95% of clinical trial participants. The lasting effects will be the same as the lasting effects of surviving the virus: immunity to COVID-19, and hopefully long-lasting immunity. The difference is that the vaccine doesn’t carry a risk of serious illness or death to you or transmission to those around you. And thankfully, neither immunity from getting the vaccine nor immunity from getting the virus itself will cause infertility. 


Aren’t the vaccine ingredients toxic?

Updated 12/29/2020

Those whom I interact with regularly who are undecided or hesitant about vaccines are typically patients and parents with sincere, legitimate questions, who deserve the time it takes to hear their concerns, answer their questions completely, and offer reassurance. But unfortunately, there are also people out there who are promoting anti-vaccine propaganda and deliberately creating false narratives. One common strategy to increase unease or paranoia about vaccinating our children is to simply list the scientific sounding ingredients and then ask, “do you really want to put that into their bodies?” Usually this approach will ignore benign sounding ingredients like “sucrose” or “gelatin”, and focus in on lengthy or scientific-sounding ingredients like “nicotinamide adenine dinucleotide” or “cetyltrimethylammonium bromide,” which register emotionally as more intimidating, less safe, and less natural. Of course we know that logically a chemical with a long name would not necessarily be any more or less dangerous than one with a short name; “ricin” has a short name, and it’s the 5th most dangerous chemical in the world (that is just an example; there is NO ricin in your vaccines. I do not want to see a bunch of memes next week claiming they put ricin in vaccines). But fear mongering is not always logical.

DANG IT

They might also home in on a naturally occurring and well known chemical that most people think about in conjunction with another of its uses, counting on that association alone to create fear. A good example is formaldehyde, which most of us think of in the context of embalming, but is also used in applications from color photography to deodorants; and of course, as an anti-bacterial and anti-fungal in certain vaccines. Some vaccines contain about .005 to .01 mg per dose; a 2 month old baby produces up to 200 times more than that every single day as a part of their normal metabolism (for adults, it’s more like 3,000 times more). Yet because our culture so strongly associates formaldehyde with death, merely invoking it’s name is enough to create unease.

Most of the ingredients in vaccines are there to keep the attenuated or killed virus pieces from decaying long before they are injected. Others are there to prevent the growth of bacteria or fungi in the vaccine vials themselves. Still others are used to stimulate the body’s immune cells around the injection site to make them more likely to produce an adequate response that leads to long-term immunity. All chemicals we encounter in our lives are toxic under certain circumstances; none of the ingredients in vaccines are toxic at the doses or in the manner given. I think people often forget that the scientists who design the vaccines, and the doctors and nurses that counsel patients about them and inject them, are human beings who also vaccinate ourselves and our children; we want vaccines to be safe for selfish reasons, too, not just altruistic ones.

That all applies to traditional vaccines; the new mRNA vaccines are made differently, and so they don’t need a lot of the same additional chemicals to ensure they work. In fact, what’s shocking about them is just how few ingredients they actually have. In addition to the messenger RNA molecules themselves, the Pfizer vaccine has just 4 synthetic fats (lipid nanoparticles) meant to deliver the mRNA into the cells that will build the COVID-19 spike protein, 4 salts to make sure the vaccine is at the same acidity and osmolality as the tissue it is being injected into so it can get absorbed (and hurt less), and 1 sugar, sucrose, to protect the vaccine during cold storage. 

Salt, fat, sugar. And that’s it.

Some of the substances can still cause a reaction; the leading theory right now is that the few anaphylactic reactions to the Pfizer vaccine were likely due to polyethylene glycol, a common chemical we give in huge doses for constipation, but which can cause an extremely rare, but serious, allergic reaction. This chemical is used to create the lipid nanoparticles through some Tony Stark level methods I can’t hope to understand. The lipid nanoparticles (very small fat molecules that can protect the mRNA) themselves are indeed new technology; which in science terms means about 30 years old. Over that time period their safety has been studied extensively and found to be safe, non-toxic, and biocompatible/biodegradable. And because the world is crazy, no, they are not tiny robots (but how cool would that be?!).

By contrast, “Nana Lipid Particles” are just the cookies she keeps sneaking your kids when you aren’t looking.
An article in 2016: “After 25 years of research…”
The math checks out.

I can’t claim to be familiar with every anti-vaccine meme and article out there, but I haven’t seen as much about ‘toxic ingredients’ with the COVID-19 vaccine, and I think that’s because even compared to the safe ingredients of traditional vaccines, the ingredients of the COVID-19 mRNA vaccines just sound very unimpressive, and thus feel less intimidating.


If I get the vaccine, can I still transmit/spread the virus?

This is a question I’ve heard frequently, especially from those who themselves work in healthcare or have vulnerable friends and loved ones. It is a question driven by compassion. In this blog we have been trying to address the fears and concerns that arise not only from conspiracy theories and misinformation, but also from the very small but real risk associated with the vaccines; yet I know that many people would brave whatever degree of risk to themselves (again, It’s very small) if it meant protecting their family and community. If they could be guaranteed that their choice to get vaccinated meant they could safely visit an unwell grandparent or have coffee face to face with a friend without any risk of spreading the virus, it would be a no brainer even if there was a considerable risk it might cause significant side effects like Bell’s Palsy (there isn’t). 

And I wish I could give that reassurance today, but while I can say that the chances are very good this vaccine will not only protect you but also protect those around you, we still need much more data to be able to quantify the degree of that protection. 

The point of the vaccines is to provide your systemic adaptive immune system, the part that acts powerfully and rapidly against specific disease, with the information it needs to produce the antibodies you need to keep you from getting very sick. A common misconception is that after you get say the flu shot, you can’t get the flu. It’s not true. The flu shot doesn’t give you a magical forcefield around your body that blocks flu virus, it just helps you fight it much, much more quickly and efficiently when you do get it; often to the point that you never even know you are infected, or at least only have very minor symptoms. Vaccines drastically reduce the chances of you becoming extremely ill from deadly disease like influenza, measles, or COVID-19; that’s their job. 

This is not how you get a cold.
He’s the best he is at what he does; but what he does is not immunology and pathophysiology.

This main function of vaccines is what underpins the epidemiology strategy of giving the COVID-19 vaccine to healthcare workers and the most vulnerable first. The medically vulnerable, because they are the most likely to require high levels of care, to suffer long-term problems from infection, or to die from COVID-19; and healthcare workers because as the pandemic worsens it becomes more and more important to preserve our medical workforce, and vaccinated folks are less likely to need sick time (much less become seriously ill and require hospitalization themselves) for COVID-19. The other reasons for vaccinating healthcare workers go back to courage, trust, and solidarity with our patients in the face of any new treatment. We are prioritizing vaccinating the vulnerable instead of say pathologic extroverts because the effectiveness of the vaccines at preventing significant illness is known (90-95%), but their effectiveness at preventing transmission is still unknown. 

So how do we find out so that Dustin can get his vaccine? Well, the big question mark is IgA antibodies. Most of the research on antibody production from COVID-19 vaccination focuses on IgM and IgG because they predominate in the blood and represent, respectively, our short-term and long-term antibody protection against systemic (whole body) illness. But IgA is the main antibody in the mucous membranes; your mouth and throat, nasal passages, lung surfaces, and digestive track (it’s also the antibody responsible for passive immunity transmitted through breastmilk), and we know that the IgA response to infection is a big, big part of what neutralizes the virus and decreases transmission in those first 10 days of symptoms. If the vaccines “only” cause a significant IgG and IgM response during that post-vaccine exposure to the COVID-19 virus, it will prevent severe infection; and may still prevent enough viral replication to slow transmission. But if it produces a strong IgA response too (or a strong enough mucosal IgG response), it will almost definitely neutralize any live virus in the upper airway as well, making transmission as unlikely as severe illness. In other words, the degree of IgA response is a strong predictor of whether the vaccine protects those around you as well as it protects you.

This is an old graphic; IgD definitely has a function. I just… Don’t understand it. https://pubmed.ncbi.nlm.nih.gov/29733429

Because of this, researchers are already studying the degree of production of mucosal IgA against COVID-19 in vaccine recipients, with some promising results, and at least one intranasal vaccine (which produce a very strong IgA response) is under development. And while the best information we could get would be to see exactly how well someone develops IgA and neutralizes the virus by studying them when they are exposed to COVID-19 after vaccination, it’s sort of hard to catch people in that window. In the end we will probably have to settle for epidemiology data instead; carefully watching to see if clusters of infection occur around exposed, asymptomatic vaccinated people at the same rate that they do around unvaccinated people. That will take time, but if and when it becomes apparent that vaccinated people really aren’t spreading the virus to those around them at all, that will be the point I’ll stop wearing my mask, practicing social distancing, and washing my hands (fine, fine; I’ll keep on washing my hands).

I realize this was a really long-winded way of saying “I have no idea,” but I want to conclude with a few reasons you should get the vaccine even if your main concern is not spreading the virus to others. First, there is already a lot of good data that supports the idea that these vaccines will provide mucosal immunity (and thus decrease transmission), both from studies of the COVID-19 vaccines themselves and from our much more robust knowledge of vaccines in general; it’s hard to say anything with much confidence yet because we’ve had these vaccines for such a short time, but I’m pretty optimist they will. We’ve followed these principles for years; we recommend everyone around a newborn be vaccinated against Pertussis (whooping cough) because the newborn can’t be, and we know that vaccine-derived herd immunity works even for viruses that are primarily spread through respiratory particles. Second, there is no conceivable mechanism by which they would increase transmission. The vaccines cannot make you produce live virus (at all) so they can’t make you contagious, and if you are exposed to COVID-19 later on your body will still respond with a mucosal immune response whether it is augmented by your vaccine or not (and it probably will be); the vaccine won’t stop that. And third, by preventing a severe systemic illness, the vaccine will decrease the amount of time you are shedding virus and prevent transmission in some of the most high-risk settings; aerosol producing procedures like nebulizer treatments or intubation in the hospital. And by preventing symptoms like coughing and sneezing the vaccine will make you less contagious when exposed to the virus, as long as you are still following other transmission control measures like wearing a mask and quarantining after exposure.

IgA response due to ChAdOx1 nCoV-19 vaccine (the tall red columns are good!)

So no, unfortunately being vaccinated against COVID-19 does not give us carte blanche to schedule giant indoor parties, throw away our masks, and treat the pandemic as if it were over; but they are a huge step in that direction, and in addition to protecting ourselves they do have a fair, if yet unproven, chance of protecting those around us too. And besides, if you don’t get vaccinated, how are you going to get your government tracking microchip?

Bad joke, sorry.


Other Vaccine Posts:

No Vaccine Selfie Yet or “Why I am uncomfortable getting vaccinated”

“𝐀 𝐂𝐎𝐕𝐈𝐃-𝟏𝟗 𝐕𝐚𝐜𝐜𝐢𝐧𝐞 𝐰𝐢𝐭𝐡 𝟗𝟓% 𝐄𝐟𝐟𝐞𝐜𝐭𝐢𝐯𝐞𝐧𝐞𝐬𝐬… 𝐓𝐞𝐥𝐥 𝐌𝐞 𝐀𝐧𝐨𝐭𝐡𝐞𝐫 𝐁𝐞𝐝𝐭𝐢𝐦𝐞 𝐒𝐭𝐨𝐫𝐲.”


Dr. Emily Smith, Friendly Neighbor Epidemiologist Vaccine Series

1. Herd immunity and vaccines: Vaccines 101 – https://tinyurl.com/y27txvro
2. Vaccine distribution info and how well do the current vaccines work? – https://tinyurl.com/y2vte5lz
3. Whoa, these were made quick, right? How can we make sure they are safe? https://tinyurl.com/y2awosyn
4. When will I get the vaccine? Who decides who gets a vaccine first? And, a note on solidarity versus individualistic thinking. – https://tinyurl.com/y39cbptv
5. Myth-busters for vaccines (we talk about fertility questions, 5G/micro-chips, fetal cells, and why the mRNA won’t change your DNA) – https://tinyurl.com/y2woz462
6. Explaining the FDA review and talking about the final Pfizer study results. https://tinyurl.com/y22jd32f
7. Should we be worried about the side-effects seen in the UK? – https://tinyurl.com/yxvb36y4
8. Let’s talk about the FDA panel meeting- https://tinyurl.com/y6hzmcgt
9. Reflections on the EUA Pfizer FDA meeting – https://tinyurl.com/y4k2o6kc
10. Pfizer EUA approval, vaccine ingredients, and recommendations – https://tinyurl.com/yyvzeynx
11. Pfizer vaccine Q&A – https://tinyurl.com/y7e3jar8
12. Will I have to get a shot every two months? Should I worry about mutations? https://tinyurl.com/y83wd84k
13. Info on the Moderna vaccine – https://tinyurl.com/y7x2hvn8
14. Let’s compare the Pfizer and Moderna vaccines – https://tinyurl.com/ybzdnqo5

What happened to the Flu?

You all remember what it was like in January and February before the COVID-19 virus had come to the United States, and before we began to treat it like a pandemic. It seemed like everyone was getting the flu, just like any normal year. The flu shot for that flu season only had about a 45% efficacy- not the worst we’ve ever had, but certainly less effective than we’d hoped- and hospitals were busy treating children, adults, and elders for complications of Flu A and Flu B. And then a couple of short months later…. *POOF!* It was like the flu had just disappeared. We didn’t hear about it anymore, nobody was talking about it; everything was COVID-19.

In March and April we began to see memes questioning why the flu had seemingly gone away. And then a few weeks after that… The memes were gone too, like magic! And for 7 whole months nobody mentioned or thought about the flu. Until a couple of weeks ago, when memes like this began to circulate again:

Isn’t is wonderful?

And although it’s only December 15th and the people posting these memes and #whereistheflu conspiracy theories are shooting their shot a bit early, I think now is a great time to answer the question, “Where is the flu?”

Contents:
-What does a normal flu season look like?
-Why doesn’t the ‘where is the flu’ theory work?
-What did happen to all the flu cases?
-What would you have to believe for these memes to be true?


What does a normal flu season look like?

The reality is that there’s really no such thing as a “normal” flu season. While different strains of influenza circulate in our communities each year, they are all unique in their own horrible ways, and we can’t predict ahead of time when we will have a mild flu season, like in 2015-2016, or when we will have a terrible flu season that threatens to overwhelm our healthcare systems like in 2017-2018, the worst I’ve experienced as a physician. But we can draw some generalizations about flu season:

  • It’s going to happen during the Winter.
  • People are going to die.
  • It’s going to suck.

I hate the flu, and even if we as a society have mostly relegated it to sitcom B plots and ‘man cold’ jokes, the reality is that it’s a killer, and I have patients with chronic respiratory diseases, compromised immune systems, or just poor overall health that I worry about every single year as flu season begins to ramp up.

We typically expect flu season to begin in early Winter, usually November, peak between December and March, and typically to be ended by April. A late flu season might last until May, but that’s fairly rare. However, the last flu season we’ve seen peak in December was back in 2014, and for the past 6 years it has been in January, February, or even mid-March.

So while I’d never fault anyone for trying to get work done early, those ‘Where are the Flu?” memes really would make more sense in January or February, when we would be expecting flu season to be peaking. Nobody finds misinformation claiming that doctors are padding the COVID-19 numbers with flu cases convincing in June and July, so I’m sure they wanted to take advantage of the cold weather for as long as possible.

And honestly I hope we are still seeing those “where is the flu?” conspiracies in February and March because the flu cases stay ridiculously low. That would be a lot better than internet memes saying “oh man, remember back in 2020 when we only had one deadly respiratory virus epidemic to deal with?”


Why doesn’t the ‘where is the flu’ theory work?

Let’s go back to that first meme at the beginning of the article, which deserves a bit more of our attention. It comes from the WHO FluNet, and anyone in the world can go to that website and look at reported flu cases for any date range going back to 1995. The first thing you’ll notice about the image is that it is on the order of tens of thousands; each major division of the Y axis is 20,000 cases. The image is supposed to convince you that the WHO just forgot to record flu cases at all as a part of this big hoax, but still published their flu numbers with empty charts for the whole world to see. Pretty incompetent conspiratoring if you ask me. But the truth is, that seemingly empty section of the graph is not empty; the 2nd image below is that same ’empty’ time frame, just with a smaller scale.

This is still an incredibly small number of cases, but it demonstrates the same week-to-week and seasonal variability flu cases normally follow; that part of the graph isn’t empty, and the data checks out.

In this context, the original image is suppose to convey two ideas; either that doctors have stopped checking for the flu altogether, or that they are ‘stealing’ flu cases and filing them under COVID-19.

The first is easy enough to answer; we haven’t stopped checking for the flu. I’ve just logged onto our electronic health record and I have a message from a colleague about a positive Flu case. We are ordering the tests, and some of them are positive. How reliable flu testing is at baseline is a topic for another day; at the very least it can be compared from year to year to help us understand how relatively bad the flu season is. As a physician I rarely order flu tests, but I’m not the one driving this data; and in fact, with COVID-19 causing similar but not identical symptoms to influenza, I’ve personally been testing for flu more in 2020 than in any year before, because differentiating between flu and COVID-19 is now an additional utility of the flu test; I know several clinicians who are doing the same. We can look at the CDC numbers to see if we are outliers here in Waco, or if doctors are in fact still testing for the flu.

So far, labs that participate in CDC influenza monitoring have tested 232,452 Americans for the flu. At the same point last year, the number of tests reported was 265,670, but instead of having only 496 positive results and a 0.2% positivity rate, we had 15,027 positive results and a 5.7% positivity rate. And while this clearly does not include all flu tests that have been ordered since September, it is a representative sample. So we know that doctors at ordering the tests; the tests are just negative.

That leaves us with the flu cases being stolen somehow. One way for this to happen is for the flu analyzers to be calibrated to call flu tests negative so we can count them as COVID-19 instead (and by logical extension, the COVID-19 machines calibrated to detect flu and call it COVID). The problem with that is that every lab has a different strategy for testing these two viruses. Many labs use completely different machines to test for COVID-19 and flu, and their flu machines have been utterly uninvolved with their COVID testing strategy; untouched, with no updates or software downloads that would cause them to stop detecting flu. There are even lots of clinics that don’t test for COVID-19 at all; have they had their rapid flu tests updated to stop detecting flu, and are now just going through the motions of collecting flu swabs to make some other lab’s COVID-19 results more believable? It’s not just far fetched because of the unbelievable extent of involvement such a conspiracy would require, but because so many people would have to be a part of it even when they are far removed from the COVID-19 testing process and apparently have nothing to gain.

A more parsimonious theory is that the tests are being run as normal, but the CDC is changing the numbers. We track flu tests in the US to determine the positivity rate and understand when flu season begins, when it peaks, and when it ends. We use other metrics like excess mortality to really understand the full impact of a flu season and estimate the number of cases. Right now, the laboratory result tracking is telling us that there just isn’t appreciable community transmission; but what if the CDC has moved all of the positives over to COVID-19? By this point last year there had been 15,027 positive flu tests reported to the CDC. In that same time period this year, we’ve had 9,755,813 new COVID-19 cases (including me!). So those flu cases would represent approximately 0.15% of all of the new laboratory confirmed cases of COVID-19 reported in the US since monitoring for the new flu season began at the end of September. Shifting the flu tests we track to COVID-19 wouldn’t just be a dishonest and transparent strategy for inflating the pandemic numbers, it would also be entirely ineffective and unnecessary. If they just reported flu cases like normal, the COVID-19 numbers would be almost exactly the same, and they’d be far less likely to get caught. If you are trying to embezzle millions of dollars from the bank, you don’t cook up a fake set of books and then turn around and stiff your customers a couple of bucks when they come in to cash their checks, too (I am currently in the market for a much better financial analogy. Please send suggestions to tjwebb@tjwebbmd.com).

Claiming that the COVID-19 numbers are being inflated with influenza cases also does absolutely nothing to explain two important facts about the pandemic; the pattern of cases over time, and the number of deaths. If we were ever to see even a fraction of the number of deaths due to seasonal influenza that we are right now from COVID-19, especially this early in flu season, we would be dealing with the worst flu since the Spanish Flu of 1918. If that were the case, the flu itself would be a pandemic exactly as bad as COVID-19… So why all the pretending? The numbers also don’t fit the pattern of seasonal flu at all. Look on the graph below and tell me when ‘they’ would have switched to using the flu to generate COVID-19 numbers. October 10th? That’s when cases really began to climb, and that’s too early for flu season. What about the cases in April, or the nationwide surge in July?

The “What Happened to the Flu?” conspiracy is extremely weak because not only does it have no explanatory power, it also has to be combined with multiple other conspiracy theories (like “the doctors are lying on the death certificates“) to work at all.

I think a lot of people find the apparent absence of the flu convincing, and I think I understand where they are coming from. Most of us aren’t used to thinking like epidemiologists. I’m not. We know people who had COVID and were fine, just like we know people every year who get the flu and are fine. If we know someone who died of COVID, as I do, it’s a tragedy; just like it’s a tragedy if we know someone who died of influenza. But we aren’t actually very good at looking at the world around us and intuitively understanding the scale of a normal flu season versus the scale of a global pandemic. So noticing a decrease in one is enough to allow us- if we really want to be convinced- to dismiss or explain away the other; until we actually look at the real numbers.


What did happen to all the flu cases?

The reality is that the CDC and the WHO are reporting such a small number of positive flu tests because… there are a lot fewer cases of the flu. And although experts have told us to expect a particularly light flu season for months, it begs the question; is it really possible for it to be this light?

The answer is yes, thankfully, and for some very good reasons. First, as we’ve been saying, it’s still very early in flu season; we just don’t know how bad the peak will end up being yet, though these early numbers are a very good sign. Second, flu vaccination rates are actually higher this year than last. With the flu vaccine typically being between 40 and 60 percent effective, even a modest increase in flu shots will result in millions of fewer cases. But more importantly, we can expect a light flu season because every single measure we use to decrease COVID-19 transmission decreases transmission of the flu too. Decreased indoor gatherings, wearing masks that block respiratory particles, a significant portion of the population working from home, doing remote learning, and sheltering in place; all of these are going to decrease transmission of influenza even better than transmission of COVID-19. Why better? Because the flu is less contagious, for one thing; it is less efficient at spreading from person to person and therefore it is easier to mitigate with masks and distancing. But even more important is the fact that some of our strategies that are only modestly effective for COVID-19 are actually very effective for influenza.

Take symptom monitoring for instance. Right now every school, daycare and university, and most businesses, are carefully monitoring their students and employees for infectious symptoms like cough, nausea, and fever, and insisting they miss school or work and see a doctor if they are ill. Because COVID-19 is spread even by people who are asymptomatic or who have not yet developed symptoms, this strategy is only effective for symptomatic COVID-19. There is also a long lead time for COVID-19 during which a pre-symptomatic patient can spread the virus before they are sick enough to screen positive and be told to stay home; the incubation period of the virus is up to 14 days or longer, with most people developing symptoms around day 6-7 on average. Prior to this, they are at work and school and don’t realize they can infect others. That’s why this strategy absolutely has to be paired with excellent contact tracing and quarantine for close contacts. But our contact tracing system in the US failed early on, and between American individualist culture and misinformation and conspiracy theories about the virus, quarantine of close contacts has been the single hardest measure to generate buy-in for.

Contrast this with influenza, which has a 1-4 day (average 2 days) incubation window and is far less transmissible in asymptomatic or pre-symptomatic patients. By the time a person is able to spread the flu, they have symptoms of the flu. In normal years a fever or vomiting might cause them to stay home, but they can continue to work or go to school with mild to moderate flu symptoms like cough and sore throat; but not in 2020, when even the social condemnation attached to coughing in public is enough to keep a lot of us at home when our allergies are acting up. Keeping people who feel well in quarantine because of exposure to the virus was always going to be a hard sale, even when that advice is based on solid epidemiology principles. Fortunately, slowing the flu doesn’t depend on that particular strategy.

Is that enough memes? That feels like more than enough. You get the idea.

It also bears pointing out that the mitigation measures for COVID-19 actually have worked, and are working. Those who want to minimize or deny the realities of this horrible pandemic are fond of pointing to the early models that predicted greater than 1 million deaths in the US and asking, “what happened to all the deaths?” But those were predictions about what would happen without mitigation, and having already reached 307,000 deaths with extensive mitigation efforts, those early numbers now feel like low estimates instead of end-of-the-world scenarios. Because strategies to reduce COVID transmission are being followed or ignored to more or less of a degree not in different states or cities but in different houses on your street (and even by different people in your own house), we will never really know which mitigation measures were most effective or how effective they might have been with higher engagement; but it is clear that even with actual levels of adherence, they are even more effective for the flu than for COVID-19, which makes perfect sense when you compare the characteristics of the two viruses.


What would you have to believe for these memes to be true?

Finally, I want us to really stop and ask ourselves, if these memes and commentaries were true, what would we have to believe? First, let’s reiterate that the people creating these mean one of 3 things:

  1. Where are the flu cases? The flu cases are there, but doctors and the CDC have decided to ignore them altogether.
  2. Where are the flu cases? A lot of the tests for COVID-19 are actually positive tests for the flu, but they aren’t being reported that way.
  3. Where are the flu cases? Oh wow! It’s so wonderful that we aren’t seeing much flu activity right now.

Since we can rule out the 3rd one (even thought it is, actually, the one supported by the facts), it has to be some combination of the first two. And in order to find those ideas convincing, here’s what you have to believe.

Warning: Most of what follows is sarcasm.
(so please don’t quote me on any of this out of context)

– Your local clinic doctors (including me), who hate the flu and COVID-19 and have lost patients to both, are waking up every morning, going into work in full PPE, and seeing patients for cough and fever.
– They are spending 10-15 minutes talking face to face with patients about COVID-19, about the safety precautions and how to do isolation and quarantine, what red-flags to watch out for, and offering heartfelt reassurance and telling their patients not to be afraid, but to stay vigilant in monitoring their symptoms. Sometimes they are even praying with them at the end of those visits.
– This is all a waste of breath and they know it. It’s a big sham, and they are play-acting their part. They know full well that whether their patient has a cold, or seasonal allergies, or the flu, they are going to call it COVID-19 anyway (and go ahead and ignore the fact that we are telling people ‘hey I think this is actually just your allergies’ all the time. If we wanted to inflate COVID-19 numbers we could do it all day long. But we don’t and we aren’t). They’ve spent all these years trying to help people fight disease, and now they are going to spend their time lying to people, leaving them less prepared for and knowledgable about the disease they actually have. And because they don’t give you a new patient panel when you sign up for a global conspiracy, they are actually lying to the same people they’ve spent all of those years trying to help as their primary care doctor.

I realize this is the worst possible gif and the opposite of my point.
I just really like this movie.

– They order a COVID-19 test and the nurse collects a sample and brings it to the lab tech, who places it in a machine to test for COVID-19; maybe they are also running a flu test for that patient. But the flu analyzer has been programmed to call the flu test negative and the COVID-19 analyzer has been programmed to call the flu COVID instead. Why test for anything at all; why not just call a certain percentage positive and have done?
– The clinic doc gets the fake COVID-19 test back and tells you it’s positive, and advises you to isolate for 10 days. This is because they… Hate your job, I guess, and want to make you stay home so you won’t get paid? I mean, I write letters for patients to help them get work accommodations for their medical conditions all week long, and I even call managers, bosses, and HR reps to make sure my patient isn’t at risk of losing their job because of a medical issue. I’ve helped people with their depression and anxiety every day for years, a lot of it because of financial difficulties. I’ve even connected people with legal resources so they could fight to keep working when they were wrongfully terminated because of their health. But sure, I guess it makes sense that I want my patients to face more financial hardships and want their lives to be worse. That’s what really lights the fire under us to make all those sacrifices in medical school and residency.
– The doctor knows you have the flu, but instead of seeing if you are one of the people that might benefit from Tamiflu (it’s not as good of a medicine as you might think), they withhold that medicine because offering it to you would give away the game, and of course their commitment to this fake pandemic is greater than their commitment to helping their patients or their Oath.
– You ask the doctor about your young children; are they going to be ok? Even though they know that children under 5 (including two of my own), and especially under 2 are at high risk for complications from the flu, they go ahead and offer fake reassurances. “I don’t want you to be afraid,” they say, “thankfully, your children are at much lower risk from this virus than even a healthy young adult.” That probably eats at them a bit, lying to you about whether or not your kids are in danger; but they are just really committed to this conspiracy.

– Meanwhile, by the way, their colleagues in the hospital are spending even more hours and making even more personal sacrifices to treat incredibly sick hospitalized patients. Instead of treating them like normal pneumonia, flu, and heart attack patients, they are calling them all ‘COVID-19’ and treating them with steroids, prone positioning, anti-virals, and convalescent plasma; all to maintain the ruse. It wouldn’t look good for the numbers to only be bad in clinic.
– Finally it’s time for the doctor and the nurse and the lab tech to send their fake lab results to the county health department, and then on to the CDC. Here the CDC, rather than reporting fake numbers that perfectly match their false narrative, will carefully tabulate the fake lab results they’ve received from all over the country, throwing in a few positive Flu cases and different flu strains (including some their experts didn’t recommend we vaccinate against) just for good measure. Seems like an awful lot of trouble.

Also, by having an incredibly mild flu season and diverting all of those flu numbers to COVID-19 (even though, again, they aren’t really needed), they allow graphs like the one in this article that make it really obvious to any conspiracy theorist on the internet what’s going on. Such an intricate conspiracy, but so poorly executed.

And why do we do all of this? Well, because fear of the pandemic helps shutdown the economy and hurts your political candidate, according to one theory (I still don’t know how they convinced all of my conservative, Republican doctors to go along with it). You would think there’d be an argument that two contagious killer viruses might convince people to stay home even better than one… Or, according to another theory, to sell COVID-19 vaccines for big pharma. Because everyone knows I get daily instructions from my pharmacy sales rep masters, instead of, you know, barely tolerating being forced to occasionally interact with them so I can get some free insulin samples for my patients. I suppose flu shots just aren’t as profitable.

Not you Gus! I didn’t mean it.

Which brings up another good point. Besides the doctors and nurses and lab techs and of course the CDC, who else would need to be complicit in this scheme? Well, Hoffmann-La Roche Inc. and Gilead Sciences, for one, the manufacturers of Tamiflu. I don’t prescribe it much myself, but during flu season it’s one of the most commonly prescribed medications. That company also makes Remdesivir, one of the medicines used for certain COVID-19 patients; but only in the hospital. Bad work on their accounting department, sacrificing most of their sales from a widely prescribed outpatient medication to focus exclusively on an inpatient medication prescribed only for some patients.

I’m not willing to put anything past drug companies, but it does seem like allowing for a ‘normal’ flu season would at least help them hedge their bets a bit. Then again, Tamiflu is available as a generic now too, so maybe this is a corporate high risk, high reward gamble. Let’s move on.

Who else would have to be complicit in it? These guys:
Sanofi Pasteur, Inc
Seqirus, Inc.
GlaxoSmithKline Biologicals
Protein Sciences Corporation
MedImmune, LLC

Recognize them? Those are the top manufacturers of seasonal flu vaccines, and none of them has a COVID-19 vaccine (at least not one close to being approved). The companies that make the two vaccines currently approved or about to be approved for COVID-19, Moderna and Pfizer, do not have seasonal flu vaccines.

You write the script. Powerful, multi-billion dollar pharmaceutical companies that have lost the race to create a vaccine against a hoax virus (or didn’t even try), and now are missing out on all of that sweet, sweet COVID money. They know it’s a hoax and more than likely have some proof. So what do they do? They expose it for what it is, involving their competitors in scandal and allowing them to grab a greater market share and keep their flu vaccine as the most important vaccine of 2020. Except that’s not what they’ve done; if you go to any of their websites, you are going to see messages saying, basically, “good job on developing those COVID-19 vaccines you guys, we are rooting for you.” Sincere? Who knows. But definitely not the type of corporate warfare you would expect if they knew the virus wasn’t really that dangerous and were missing out on all the fear-monger profits.

Now, I know what you are going to say. ‘Fine, maybe it isn’t the doctors and nurses, maybe it’s just the CDC and the WHO. And hey, thanks for not including me in your global conspiracy. Let’s say that this is a regular flu season, or even a particularly bad flu season. That means that say hundreds of people a day are dying (or 3,000, if you are saying all COVID-19 cases are really the flu), and hundreds of thousands are getting the flu, and the doctors are… What? Too dumb to know the difference? Too lethargic to figure out what’s flu and what’s COVID-19? If we aren’t in on it, then we are either too dumb or too complacent to notice it; you know, the two primary things doctors are known for, being stupid and lazy. Every day at our COVID-19 outdoor clinic I hear the same conversation between doctors that are floating there to help; “have you guys seen much flu yet?” And every day I hear the same answers; “not really” and “I’ve had a couple.” If we were in the midst of a bad flu season right now and it were being covered up, you’d have hundreds of thousands of doctors, nurse practitioners, physician assistants, nurses, and all sorts of healthcare workers blowing the whistle, not just a couple of drug reps posting their text messages on Parler. Instead what those clinicians are saying is, “COVID is really bad right now. Please wear a mask. Our hospitals are overwhelmed; thank God the flu isn’t bad right now too.”

“Why Don’t Doctors…?”

A friend re-posted this meme and the list of questions below recently, and I want to clarify at the outset that they were interested in a response from their friends in the medical field, not trying to perpetuate the misinformation, nonsense, and deliberate misrepresentations the original author is promoting. While it takes only a sentence or two to ask a nonsensical or disingenuous question or blast some ridiculous health misinformation, a careful and satisfactory answer will probably take a bit longer. Because of this, I’ve decided to tackle these one question at a time over the next few weeks, and will update this blog post with my responses as I go.


One last preliminary; we should recognize two things about the comic above, besides the fact that it’s pretty standard COVID-19 misinformation (“ooh they want you to wear a mask but nobody will tell you to be healthy! No medical expert has ever recommended people exercise before!”). First, it has pretty much nothing to do with the rest of the post. Second, it’s a riff off of the comic below from Mike Baldwin, author of the Cornered single-panel newspaper comic.

Mr. Baldwin is an apolitical cartoonist, and I can’t find anything in his writings that would give me the impression he would endorse this list of complaints about doctors; but of course I can’t find anything to disprove it either. There is one comic where a doctor had removed someone’s entire intestine because his “stomach was all tied up in knots,” so take from that what you will. Still, if the original author is going to start this whole thing off with a stolen and poorly revised comic strip, best to give some credit to the actual cartoonist (whose original comic was more poignant anyway).


We Have Questions”


12/6/2020: Why don’t doctors tell you to take magnesium instead of stool softeners (which dehydrates the bowel)?

Before I even dive into these, I have the definite sense that the number of “Wait, What?!” moments I encounter in responding to this post is going to be extremely high. In fact, with just a cursory glance at this long list of “questions,” I’m really not sure whether the “Wait, What?!’s” are going to outnumber the “Um… We Do’s”. I think I’ll keep score. 

This post is a good example of both. 

Um… We Do
First, let’s be clear what they mean when they say ‘why don’t doctors tell you to take magnesium?’ Surely they mean a laxative compound like Magnesium Citrate or Magnesium Oxide, the active ingredient in Milk of Magnesia. These are commonly used over-the-counter laxatives, and I think we can give the benefit of the doubt that the original author is not here advocating for anything like high doses of magnesium salts like Mag Gluconate or Mag Chloride, typically used to treat magnesium deficiency, as a first line treatment for constipation. Your kidneys will thank you if you don’t overdose on magnesium supplements.

And assuming that this is indeed the form of magnesium they are discussing for constipation, of course we recommend this to patients- when it is indicated. When a patient comes to me with complaints of constipation, the first thing I do is listen to the history of their constipation, including what they’ve already tried for it and whether it was helpful. This helps me both to diagnose whether their constipation is actually due to an underlying medical condition that will need additional work-up, and to make sure that I am not recommending treatment options that they have already tried and found to be ineffective. In general, here are my recommendations for constipation, and usually in this order:

  • Increased water intake, increased exercise and walking, dietary changes. 
  • Increased dietary fiber, including either food sources or fiber supplementation. 
  • Stool softeners including colace, which are more gentle than laxatives but generally less effective.
  • Laxatives, ranging from dietary options that include sorbitol (prunes and prune juices) to polyethylene glycol and milk of magnesia or mag citrate. 
  • Combination stool-softener/pro-motility agents like sennosides.
  • Finally rectal suppositories and enemas, not because they are a worse option than the others but because the patient will pretty much only try these if they have already tried everything else and are now truly desperate. 

Because my patients’ time is valuable and I trust them to make good healthcare choices with appropriate advice, we usually briefly discuss the risks and benefits, potential side effects, and stepwise strategy for all of these types of agents; I don’t tell them to drink more water and do some lunges and see me in two weeks if they still haven’t pooped. So it’s fair to say that while Milk of Magnesia or Mag Citrate are not by any means my go-to medications for constipation, I do talk about it as an option with patients very regularly (ha, ‘regularly’. Get it?) If these medications are both readily available OTC medications that you can buy at your local pharmacy and are commonly discussed with patients, why did the OP decide to focus in on it as the one hidden, secret treatment for constipation that doctors won’t tell you about? I don’t really know, but probably because it sounds more natural to invoke an element like ‘magnesium’ than “Sodium 1,4-bis(2-ethylhexoxy)-1,4-dioxobutane-2-sulfonate”… Though I usually shorten this to ‘docusate’ and in fact (in the spirit of full disclosure) had to google that chemical formula (obviously). And in the alternative health world, unfortunately, sounding natural and crunchy is too often more important than the actual efficacy, side effect profile, and safety of the treatments being recommended. One should ask, why didn’t the author complain that doctors recommend magnesium laxatives and stool softeners instead of increased water intake and yoga, both of which have been proven to help with constipation?

Wait, What?!
Before we move on, we should also address this “dehydrates the bowel” aspect of the post. Because of the beautiful and very intricate fluid homeostasis the body maintains, there’s really no such thing as ‘gut dehydration’ outside of two situations; total body dehydration, which is of course associated with constipation but also a whole host of temporary and potentially chronic problems resulting from poor blood flow and oxygen delivery to vital organs; and medical conditions that result in dysfunction of the normal transport of fluid and ions into the intestinal lumen, such as in Cystic Fibrosis where deficiency and dysfunction of the cystic fibrosis transmembrane conductance regulator (CFTR) protein results in decreased free fluid (and bicarbonate) in the gut and thus accumulation and alteration of intestinal mucous and eventual obstruction. So what are they talking about here?

As best I can tell, they must be referring to the fact that some medications commonly used for constipation work by drawing free fluid into the lumen of the gut from the intracellular space by changing the osmotic gradient of the intestines. While it’s true that this could lead to total body dehydration if the fluid is not replaced with oral hydration, most people who are taking medications for constipation (and all that are following their doctor’s advice and don’t have contraindications) will be increasing their fluid intake as well. The more likely risk is diarrhea, abdominal cramping, and bloating. Which medications do this? The ones that contain magnesium, among others. But not all agents work that way; some actually work by increasing the peristalsis of the intestines (similar to how exercise helps constipation), while others help the thickened, firm stool mix better with the free fluid and fats that are already in the intestinal lumen, which is exactly what that fluid is there for in the first place. Here’s a handy chart so you can see how each of these agents works:

So if you are going to complain that anything that mixes stool and fluid together in order to ease bowel movements “dehydrates the guts,” you are going to be complaining about some of the gentlest, safest, and most natural approaches to constipation, including things like upping your fiber intake and cooking with olive oil. If you wanted to go the pulling-fluid-into-the-intestinal-lumen-through-osmotic-changes route, you could definitely go with the magnesium citrate or the magnesium hydroxide the original author is talking about; but let’s not pretend like they are the crunchiest or most natural options available when you had to walk past all of those sorbitol rich prunes, pears, and apricots in the produce section on your way to the pharmacy to buy them.

Um… We Do: 1
Wait, What?!: 1


Why don’t doctors tell you to change your diet when you have heart burn and indigestion instead of you taking Prilosec (which causes more heartburn, colon cancer, osteoporosis and leaves food fermenting in your body)?


Why don’t doctors tell you that HERBS heal? That FOOD heals? 


Why don’t doctors teach you how to lower toxic chemicals in your home when you have constant headaches and allergies? Fragrances and chemicals cause toxic buildup in our cells and can cause more allergies and headaches!


Why aren’t you informed by your doctor that if you eat a grapefruit everyday, it will lower your blood pressure naturally and you don’t need (pills)(this is why a person can’t eat it while on blood pressure meds)?


Why doesn’t your doctor tell you to take activated charcoal for headaches, bloating/gas, skin issues, colds, the flu, food poisoning (activated charcoal bonds waste and toxins and safely removes them from the body)?


Why don’t doctors tell you about herbs and herbal teas to support immune and digestive functions (different herbs help different organs do their jobs to keep the body healthy)?


Why isn’t your doctor suggesting that you take a probiotic daily (this boosts immune function, helps clean and balance the bowel, helps regulate absorption and elimination, and keeps colds and allergies at bay)?


Why don’t doctors teach the value of breastfeeding instead of telling you to use formula instead? Breastmilk is a baby’s very first defense in health outside of the womb! It adapts to what a child needs at each individual feeding, and is THE MOST powerful thing that builds and supports an immune system in a baby. 


Why doesn’t your doctor provide you with any in depth information or package inserts for your vaccines before injecting yourself or your child (they don’t disclose that there are aborted fetal cells, cow cells, African monkey cells and dog cells, along with many other adjuvants like mercury and aluminum and formaldehyde…. none of which are beneficial to the body)?


Why don’t doctors teach you that you store negative emotions in your physical body which can cause you physical pain and sickness, instead of saying you need a (pill) 

(emotions play a very significant roll in our total health, without tools to help navigate our emotions, we can easily become ill)? 


Why don’t doctors tell you when they take a whole organ from your body, that you’re still going to suffer, you just will suffer in a new way (organs are all useful, we need them for many reasons, and most organs can be healed completely without removing anything)?


Why do they set up protocols for prescriptions that most of them wouldn’t even take themselves? 


Why don’t doctors take a real role in helping people live better lives?


COVID-19 Vaccine Misinformation (minute-by-minute analysis)

After weeks of COVID-19 misinformation being a secondary or minor issue- to me because we have been so busy actually diagnosing and treating the virus, and to the country in general because election misinformation was much more interesting- I suddenly find myself with more pieces of misinformation to write about than I could possibly make time for. There is this meme that probably needs some attention as people who haven’t complied with mitigation measures since March threaten non-compliance with any future mitigation measures because the mitigation measures they already didn’t comply with didn’t work (because they didn’t comply with them). If I get time I’d love to explore that a little further (and, I should hope, a bit more graciously than I did in that last snarky sentence).

This reminds me of the great Chesterton quote; “Christianity has not been tried and found wanting. It has been found difficult; and left untried.” Could we say the same thing about self-quarantine, shelter in place measures, and especially lockdown efforts? And what then shall we say about wearing masks? “It has been found slightly inconvenient and inexplicably controversial, and tried only begrudgingly and inconsistently?”

There’s also a discussion that we need to have, as a nation, about how this pandemic didn’t go away on November 4th and isn’t going to go away when we have a new president in the White House. This virus is pitilessly apolitical. It doesn’t care about Republicans and Democrats, the electoral college, lawsuits in Pennsylvania, or any of the other big problems facing our democracy (did I just include Republicans and Democrats in the list of problems facing our country? Yes, yes I did). In an election year, and particularly one this contentious, there was never any chance that information and understanding about the pandemic would fail to fall out along party lines. Now that the election is over, is it possible for us to drop our politicized misinformation and as a countrymen find some common ground on which to fight this deadly virus together? Probably not. But it doesn’t mean I can’t rant about it for five or six thousand words.

But I think the most pressing is the video I’ll share a little way below, which was sent to me by a Facebook friend. It’s a short misinformation video about the COVID-19 vaccines that are being developed and, like most misinformation, is an amalgam of half-truths, deliberate misrepresentations, and outright lies. It’s very short and I’ve posted it here in it’s entirety with the hope that you will read the accompanying discussion and not just watch the video.


Will I get the COVID-19 Vaccine?

Let me start with a statement that might be a bit controversial; while I’m obviously strongly leaning that way, and hope I have the decision put before me as soon as possible, I haven’t absolutely decided whether or not I will get the COVID-19 vaccine once it is available. That might sound like heresy coming from a doctor, particularly when we are currently in midst of the worst wave of the deadliest pandemic of our lifetimes.

But let me explain what I mean. While it’s encouraging to hear that the new vaccine from Pfizer is 95% effective against this very, very deadly virus, and while a safe and effective and widely accepted vaccine is the best and quickest route we have to beating the COVID-19 pandemic without even more massive loss of life, I remain at heart and by training a scientist, not a science fan; I default to skepticism of any new discoveries or developments until I have reviewed the evidence for myself. With regards to the COVID-19 vaccines that have been in development over the past year, I am like most physicians cautiously optimistic. Before deciding to have the vaccine administered to myself and my four children, however, I plan to review all the data that I can in order to ensure my choice is as informed and sound as possible, just like I would for any medication, surgery, or any other intervention my doctor recommends (or, for that matter, any treatment or medication that I recommend to my patients).

“But Dr. Webb, this is exactly what anti-vax parents are doing when they refuse vaccines.”

Yeah, except that it isn’t. At least, not generally. You see, when I say I plan to review the data I mean the actual data from the clinical trials and independent studies, not misinformation and propaganda. If you are like me and have the privilege of scientific training that allows you to independently parse the information contained in published clinical trials, you probably have no desire whatsoever to outsource this type of academic work to people who do not have that training and who are approaching the information with blatant and unabashed bias. But if you do not have the background to do that work yourself, you still deserve the same degree of reassurance and comfort before choosing to accept a vaccine or have it given to your children; it is just less likely that you have access to the resources you need. The anti-vaccine movement knows this and it is in this gap- the gap between the confidence you need for such an important decision and the degree of explanation, information, and reassurance that you are generally given– that they do their best (or most effective) work.

Who is to blame? Well, obviously, I am. Your local doctor, your pediatrician, your PCP; we carry the burden not of fighting propaganda, the blame for which rightly rests on those creating and spreading it, but of helping you become resilient against propaganda and misinformation through patient-centered health education.

So I am begging you, if you are at all wary of or uncertain about a COVID-19 vaccine, and if you do not have the technical background or family/community resources you need to review the source data independently, ask your primary care doctor. Maybe even give them a heads up when you schedule an appointment so they can look into it beforehand (they probably already will have). If they are active on social media, ask them if they would be willing to write about it and share it openly. Some primary care physicians, like Dr. Ben Brashear here in Texas, believe so strongly in this type of work that they have devoted a large amount of their time and energy to helping their patients and other readers navigate these issues through their clinic websites and social media pages. I think this is the single most effective way to combat Social Media Misinformation; with a hundred or a thousand or ten thousand doctors and scientists in small towns like mine or Dr. Brashear’s helping patients whom they have already built a trusting doctor-patient relationship with navigate what information is reliable and what isn’t.

And of course, on the off-chance that over the past 6 months of my writing these blog posts you have somehow decided you actually trust me, I’ll plan to write a short post about my decision on the vaccine as soon as I’ve decided, for certain, what to do for myself and my family.

I should also point out, while we are dispensing with preliminaries, that this post is not designed to be an overview of the research and development of the various COVID-19 vaccines. For that I will point you to my hero, Baylor Friendly Neighbor Epidemiologist Dr. Emily Smith.


“The ChAd Vaccine” Video Minute-By-Minute Discussion


0:12 Share this everywhere!

I’ve been doing this sort of misinformation debunking work as a hobby for about 8 months now and I’ve come to recognize some of the language or verbiage that ought to make us extremely suspicious that the information we are about to be given is not necessarily reliable. The speaker hits several right out of the gate:

  • This is a fact.”
    • In my experience, things that are facts don’t need the disclaimer “this is a fact.” Both for people spreading misinformation and those of us fighting it, the goal has to be to lay out such a clear and compelling case for the facts that the rhetorical sledgehammer of “I’m telling you the truth, I wouldn’t lie to you” is as unnecessary as it is hollow. If someone finds this verbiage convincing, it is likely because they are anxious to be convinced; and it should put you on your guard. “Let your ‘Yes’ be ‘Yes,’ and your ‘No,’ ‘No.’ For whatever is more than these is from the evil one.” -Matthew 5:37
  • Share this everywhere.”
    • Similar to the last point, I believe that most people giving reliable, expert advice or guidance will never ask you to “share” something they have written. Why? Because the burden of demonstrating that an issue is so important and pressing that it should be shared broadly lies again with the author, and lies in the substance and veracity of the arguments, not with the mere desire of seeing their assertions disseminated broadly. Nevertheless, I do recognize that “share this now” is a part of our vernacular now and used by almost everyone of a certain generation on back; but I think it is most suspicious as a herald of misinformation when it is accompanied by….
  • They will take this down.”
    • I sure that at some point something I write, either here or just on just on social media, will be taken down or marked as inaccurate; and when that happens I will probably throw a fit like I’ve seen others do. Until then, I will hold onto the sanctimonious belief that only those intending to spread misinformation feel that it is necessary to preface each video, meme, and essay with “this will be removed” or “they don’t want you to know this.” Who, exactly? The expansiveness, complexity, absolute loyalty, and conflicting goals and values of all of these conspiracies you believe are striving to prevent you from seeing some silly video are really beyond belief. The reality is that most scientists don’t mind at all if you watch the Plandemic documentary or Dr. Stella Immanuel’s speech on capitol hill; what matters is that you know going into it that this misinformation has already been disproven, and that you are armed with the understanding and data you need to work through and decode it. This presents an easy enough decision for me; my goal of helping you sort through this misinformation is best served when it is accompanied by the source material, and posting the video alongside the discussion is a no-brainer. But I think it’s a much more difficult decision for Facebook, Youtube, and Twitter, because they have to worry about the viral nature of this misinformation and the real potential for harm, and can’t accompany every repost or upload with a detailed analysis. Allowing lies to circulate without any disclaimer or precautions to protect those that are easily deceived is irresponsible and cruel; it submits to the whims of anyone with any lie to tell or anything to sell. But the very act of censoring or cautioning about misinformation also serves to reinforce the narrative of oppression; the last redoubt for conspiracy theorists is to use the very censure called down onto themselves for the unreliability of their assertions as proof of their veracity. It is a poor sort of fortress to be sure; yet there are far, far too many who see it as the last citadel of truth.
  • And, saddest of all, “Share to all of your Bible groups.”
    • We will talk about the specifics of what misinformation or misrepresentations in this video specifically might appeal to certain streams or factions within Christianity, but for the time being all I can do is grieve, as a follower of Christ, that a video or meme about the pandemic being spread primarily or at a higher velocity within Christian circles is so often a sure sign that it contains little truth and much that is meant to deceive and disrupt efforts of self-sacrifice and self-denial on behalf of our neighbors and community. I have written about how I believe the Church ought to respond to misinformation and why, but it really does feel as though we are behind the World in this area, both in our discernment and in our charity. Lord Jesus, please teach us to be as wise as serpents so that we might be as harmless as doves!

0:26 “Share with… Anybody that doesn’t want aborted fetal tissue fragments put into them.”

This is actually a major claim of the video and the most compelling topic of discussion of the three the speaker introduces, and we will cover it more extensively in just a couple of minutes. For now, let me just say that it is a fact that the COVID-19 vaccine, or any vaccine for that matter, does not contain any aborted fetal tissue fragments! Share with your Bible group, they will take this down!

It also won’t change your DNA, but we’ll get to that too.


0:40 This is the packaging of the AstraZeneca COVID-19 vaccine.

I have not seen the packaging of the AstraZeneca vaccine or any others for COVID-19 and have no reason to believe this individual photoshopped this package (and compelling reasons to believe they are not capable of doing so, as we shall see).


0:59 “It’s called Chad”

ChAdOx1 stands for Chimpanzee derived Adenovirus-vectored vaccine developed by Oxford University. The 1 means it’s the first of multiple Chimpanzee derived Adenovirus-vectored vaccines for COVID-19 that Oxford is working on.

It does not stand for “Chad- whatever that is, zero, or whatever it is- times one.”


1:19 Go to ResearchSquare.com

Research Square is a fine website, just be aware anything you read there is in pre-print; it hasn’t been finalized or peer reviewed yet. That’s the whole point of the website, for people to get feedback before they publish.


1:21 “I want you to learn to do your own research.”

The speaker claims that she wants her viewers to “do their own research” and begins well enough by directing them to Research Square, a reputable website where you can find original sources. But within about 10 seconds she has transformed “doing your own research” into something about as academic and reliable as a Wikipedia binge (or exactly as academic and reliable, since a Wikipedia binge is exactly what it is); googling random words you don’t understand and reading about them, then deciding what you think they mean without any background or context. It’s hard to tell whether she is being intentionally deceptive here, or if she really believes that she has attained a solid grasp of these concepts through the methods she is espousing.

That’s not what research is. In the context she is using it, ‘doing your own research’ at minimum means using the amazing, abundant resources of the internet to learn more about the concepts being discussed, and then using that new knowledge to get yourself over that first hump in the Dunning-Kruger effect and figure out 1. what you need to learn next and 2. what the limits are on how much you can actually learn about this on your own. The good news is, as long as you are humble in your assessment of your own understanding, you can also use that knowledge to 3. verify the reliability of whomever you go to to learn more.

We’ve all done this before, haven’t we? When I wanted to talk to an HVAC specialist about a problem with the air supply plenum in my crawlspace, I studied the anatomy of different HVAC systems, read some discussions on HVAC forums, and watched several videos that addressed similar problems. When this didn’t fully solve my issue, I called the specialist; and I used that research, mixed with a healthy appreciation of my own general ignorance on the topic, to both improve my understanding of his recommendations and to inform my gut decision on whether to trust his expert advice or get a second opinion (for anybody who is curious, he said the squirrels shouldn’t be living in there and he’s coming out to take a look on Monday. Based on my independent research, I’ve decided I believe him… though the squirrels have been waging a fierce misinformation campaign).

I’ve written (though not yet published) about this before; I want my patients to use Google. Really. And then I want them to come and talk with me about what they’ve read so I can help them get further beyond the point they could by themselves. Like I said in the article I’ve written that nobody else has access to:

“Most of all we went to school to become very, very good at parsing information about the human body and its diseases, and when it comes to the research you’ve brought in that is the primary way I can help; by helping you sort out which information is actually going to affect you and which isn’t, which you should worry about and which you shouldn’t, and what the underlying motivations might be for the people that published it. I’ve spent countless hours looking at research and studies and clinical trials and have become very good at determining when a study design is too flawed or data is too skewed to be reliable, when there is a strong bias that makes the data suspect, or when a conclusion is not supported by the evidence as it claims. If you are a scientist or a researcher or have training in those areas you may be able to do the same, maybe just as well or better; but for most people that isn’t the case, and it would be a little silly to trust your doctor when they offer one of the services they are highly trained for, such as looking at your child’s ear and determining if there is a bacterial infection requiring antibiotics, and not trust them when they offer another service they have been highly trained for, such as telling whether the research you’ve brought in about the human body is reliable or not.”


1:28 “Don’t rely on us or anyone else, do it yourself!”

This is so subtle and clever that I just wanted to point it out briefly. “Don’t rely on us or anyone else” when doing your research is an attempt to level the playing field between the different sources you might listen to, and it seems so reasonable on the surface.. Don’t listen to me, or your doctor, or a scientist, or an epidemiologist or researcher, only listen to yourself. The problem is that, at least in the viral version of this video, we have no idea who this lady even is. Telling you not to take her word for it or your doctor’s implies those two sources of information are equally educated, informed, and reliable; this from a lady who just called it the “CHAD Zero Times One Vaccine.”


1:49 “Google every single word on here.”

Again, that’s not “research.” If you need to google some of these words to know what they mean then by all means do so; but that is the pre-research prep work, not the research itself. Thinking you understand a concept because you looked up the definition of a word is unmitigated folly, as she demonstrates in a few moments.


1:58 Recombinant DNA doesn’t mean they are reprogramming your DNA. At all.

The speaker and her assistant begin their “research” by looking up the term “Recombinant DNA” on Wikipedia. Wikipedia is great, and one of my favorite things about it is that most articles are written at a level that most lay people can understand (except the math ones. Yikes). So I think if you want to follow the speaker’s advice here and read that wikipedia article, you should. I’ll wait.

https://en.wikipedia.org/wiki/Recombinant_DNA

But the thing is, she doesn’t actually read it in this video, does she? She only reads the first sentence and then, despite her prior warnings, asks you to take her word on what that sentence means. But listen to the way she says it! The emphasis, the alarm, the righteous anger as she enunciates “molecular cloning” and “genome”! She spits the words out as though it were self-apparent how evil they are, without seeking (or asking you to seek) any additional understanding of what they actually mean. Just one googled word in, and she has entirely abandoned her ‘method’ of research; don’t google every single word in this article that you don’t understand, just take it on her authority that this is bad, bad stuff. She tells you earlier not to be intimidated by scientific terms; but here she actually wants you to be frightened by them.

If you actually read that article, you will quickly realize that the idea she implies here (and stated explicitly earlier on), that recombinant DNA reprograms your genetic code, is actually complete nonsense. In fact, it’s exactly the type of nonsense you would expect if someone’s entire understanding of the science involved was gained through googling random words and reading the first sentence only of wikipedia articles.

The Recombinant DNA got him!

Recombinant DNA describes how the vaccines or medications were developed, not what they do once they are inside of you. Just look at the ‘applications’ section of that same wikipedia article; rDNA technology has been used to develop insulin, accurate testing for HIV, and safe growth hormone for patients with pituitary failure, not to mention interferon therapy for cancer, treatments for cystic fibrosis, and TPA, a life saving treatment for strokes and heart attacks. None of these therapies change your DNA. Saying recombinant DNA therapies change your DNA is like saying that Mashed Potatoes mash you if you eat them. No, the potatoes were mashed during the preparation phase so that they would be delicious for you later on; you don’t get mashed, they do. DNA of fungal or bacterial or animal cells was changed in order to develop these treatments, so that they would be safe and effective for the people who need them.

Since I’m waxing eloquent here, I’ll give one more analogy. It’s like my first and only experience in debate club back during Freshman year of college. The topic was “is preemptive war justified.” The first team to debate, the “for” team, got to define the terms of the debate and chose to argue that preemptive war was justified because nations have the right to defend themselves if they are the victims of a preemptive attack; so preemptive war, “war initiated by a preemptive attack,” was 100% justified… on the part of the nation that was attacked first.

They changed the very definition of the term to suit the argument that was easiest to defend; they were arguing for retaliatory or defensive action instead of preemptive, because it was a much simpler position to defend. And the only problem with that is that words have meanings, Keith!

Sorry, I may still have some baggage to work through there. But that’s exactly what this speaker is doing too; changing the meaning of the term ‘recombinant DNA’ and just hoping you won’t notice or indeed read the very article she has pointed you to herself.

There is one more part of this discussion, and it doesn’t have anything to do with what she’s mentioned here, but intersects with this idea of “reprogramming DNA,” even if I don’t think she has the science background to realize it. Here she’s focused on rDNA, but you’ll also hear discussion about mRNA; messenger RNA, the genetic sequences that organisms use to instruct cellular machinery to build proteins. The two vaccines that have recently shown such promise, from Pfizer and Moderna, both use mRNA technology. Traditional vaccines provoke an immune response, teaching your body to produce it’s own antibodies to fight the infection, by presenting your immune cells with non-dangerous particles of the virus that it can recognize and then build antibodies against. Each of these viral particles has to be produced in a lab and enough of them have to be preserved and injected to ensure some are picked up by your macrophages or dendritic cells and then presented to your lymphocytes (T and B cells) to make sure that you really do develop the ability to mount a robust immune response when you exposed to the virus for real later on.

The mRNA vaccines do the exact same thing, only instead of injecting the deactivated viral proteins directly into your body, they only inject a code for them; a code that teaches the machinery in a few of your own cells to build and release the proteins needed to produce the desired immunity. This outside mRNA hijacks the cellular machinery to produce the proteins needed for immunity without any of the proteins that cause illness; and the rest functions just like a normal vaccine. This is the same naturally occurring ‘technology’ that mRNA viruses use themselves. This is great news for people who want to acquire natural immunity; by mimicking the action that the viruses themselves use, which in turn produces our immune response to them, these vaccines have become the closest you can possibly get to acquiring immunity naturally without actually running the risk of getting sick and infecting others. Instead of getting a deadly mRNA virus from a cough or sneeze, you get a safe mRNA ‘virus’ from a vaccine, and from it your body’s own immune system learns how to kill the deadly virus.

This video below explains these concepts really well, starting at the 1:53 mark.

Again, this mRNA technology doesn’t change your DNA. It just sends a message to some of your cells with a set of instructions, just like any common cold would. Your chromosomes, your genetic code, are unaffected; the vaccine doesn’t even interact with them. If an analogy would help, imagine someone ‘hacked’ your network printer at the office. Normally you are the only person who prints to this printer; you write the document on Word or Notepad (judging you) on your computer and then hit “print,” and the signal goes to the printer, which prints the document. But one day you walk in to find that someone else has been printing things to your network printer. That doesn’t mean that they’ve hacked your computer, it just means they have used your paper and ink (and toner! those monsters).

And what did they choose to print? A detailed set of instructions on how to protect your networked printer from hackers. Big Cybersecurity, at it again.


3:00 “We used direct RNA sequencing to analyse transcript expression from the ChAdOx1 nCoV-19 genome in human MRC-5 and A549 cell lines.”

Here is where we enter what is, I think, the heart of what has drawn most people to this video. I think we can quickly dispense with one piece of false information before entering a more important discussion. The ChAdOx1 nCoV-19 vaccine does not use the MRC-5 cell line. This is an inherent problem with both the ignorance of the speaker (and here I do not mean to be insulting, but merely mean the lack of actual education and experience in the field in which she puts herself forward as an expert) and the deep flaw in her ‘method’ of research. This article is not from the vaccine manufacturer at all; it’s from an independent lab that used these human cell lines to study the vaccine after it was produced. You can find the full text here and read it for yourself. The manufacturers did not use those cell lines. In telling you all about the MRC-5 cell line and warning you that;

One thing [the ChAdOx1 vaccine] definitely has is the lung tissue of a 14-week-old aborted caucasian male fetus.”

Narrator: “It doesn’t.”

the author is stating an absolute untruth based in her own haphazard and unreliable method of trying to find scientific information and uncover medical conspiracies. If her “research” methodology has left her unable to even grasp the basics of who is doing the study and why they are doing the study, or the difference between making a vaccine and studying a vaccine that has already been made, why would you possibly trust her method of research? For that matter, why trust her at all, when she has proven herself so unreliable? Even her assistant, the enigmatic Claire, tries to offer some clarification that the cell line used in the study has been replicated over and over again since the 60’s; that the researchers did not actually abort a child and then collect its cells to study the vaccine (or make the vaccine, as she mistakenly believes); but that attempt is ignored by the main speaker.


What about fetal cell lines in medical research?

Despite the speaker’s severe misunderstanding, and regardless of the tired horror tactic of trying to get you to visualize fetal parts being injected into your children in order to illicit a visceral reaction (there are no aborted fetal parts or fetal cells in vaccines, even the vaccines developed using human cell lines), this is an important question and I think we should spend some time on an actual discussion of it, instead of the sensationalized and inaccurate rage that characterizes its treatment in the video.

I am a pro-life doctor. Like most physicians my views on abortion are nuanced, deeply felt, and strongly based in the lived experiences of my patients. Since this video was designed to spark a visceral reaction among pro-life people in order to make them more susceptible to vaccine misinformation, I think the issue of abortion and fetal cell lines in research warrants discussion on this blog post. I have helped prevent countless abortions, both through providing high quality women’s health services, often to women who otherwise would not have good healthcare access, and by providing compassionate listening, patient-centered care, and judgement free counsel during the most tumultuous times of an unintended pregnancy. There are those that will argue that doctors shouldn’t be pro-life, that my moral opposition to abortion means I can never truly provide unbiased guidance and information to a woman facing this most difficult and painful decision of her life, or that I am somehow unable to respect my patients’ autonomous decision making in this area and help them leave my office more empowered than when they came in. I don’t believe that matches the experience of my patients. I might argue that informed consent, a core principle of medical ethics, is impossible without a robust patient-focused discussion of the medical realities and practical alternatives surrounding the decision to terminate a pregnancy, and that there is reason to believe that these conversations are too often sacrificed or short-circuited once the specter of abortion first arises. It is a debate for another day, to be sure, and with many of the physicians who hold the opposite view I nonetheless share a strong mutual respect, born of proven care for and dedication to our patients, that overrides even our deeply held reservations on this issue. Even on the question of abortion and consent itself, we both believe, based on all of our medical training and the high degree of altruistic concern we bring to our jobs, that we are striving to do what is best for our patients; to help them in the way that is best for them and most consistent with their own stated goals and deepest felt wishes.

Many medications and vaccines use fetal cell lines. The reason is simple; human cells typically work best for studying and developing treatment for human diseases, and fetal cells have unique characteristics that allow cells to achieve, or nearly achieve, cellular immortality; allowing the same cells to be replicated over and over again without any need for additional cell lines to be collected. There is no question that this is a challenging ethical and moral area for pro-life scientists like myself, and strongly pro-life physician and multidisciplinary healthcare organizations, like the Christian Medical and Dental Alliance (CMDA), have discussed and written extensively about it. Here are a few articles CMDA has published, written by conscientious physicians of deep, theologically sound Christian conviction. I hope you will weigh their words and reflections with at least as much gravity as a random person on the internet telling you to “pray big” and share her video with as many “christian-loving” people as possible.

Christian Medical and Dental Alliance:
Am I My Brother’s Keeper?
By Dr.
Amy Givler, MD, FAAFP

Christian Medical and Dental Alliance:
Is Vaccination Complicit with Abortion?
By Dr. Gene Rudd, MD

There are a few salient facts you should know about this area of medicine.

  1. No children are aborted or have been aborted for the purpose of developing medicines or vaccines. The sensationalism that some forces in the anti-vaccine movement are willing to engage in knows no bounds, and it is not uncommon to hear the propaganda that these unborn babies were actually aborted for the purpose of being used in medical research. This is simply wrong. The few unborn children whose cells (or accurately, copies of copies of their cells) are regularly used in medical research and development were likely aborted for the same reasons that most abortions occur; the unbelievably difficult balance of perceived goods and anticipated challenges faced by a woman who had not intended to become pregnant. These mostly occurred in the 60’s and 70’s, and cell lines (copies of cells) derived from those same aborted fetuses have continued to be used ever since without the ‘need’ to derive new cell lines from abortions occurring today. For instance, HEK 293, the actual cell line used in the development of the ChAdOx1 vaccine, was derived from an abortion in The Netherlands in 1973; we simply do not know the story of the woman who chose to have this abortion, or the reasons behind her choice.
  2. There are no fetal cells in vaccines; not even in vaccines developed using fetal cell lines. Vaccines are not a ‘mix’ of fetal cells and viral particles, not by any stretch of the imagination. When fetal cell lines are used to grow viruses that infect humans in the vaccine development process, it is distant to the final product of the vaccine, which has also been through multiple rounds of purification. The human cell lines are used to grow the virus and deactivate it; they are not included in the actual material injected through a syringe to produce an immune response in our bodies.
  3. Not all vaccines use human cell lines. There are vaccines for almost every vaccine preventable illness that are designed using methods that even the most rigorous pro-life groups consider ethical. When the anti-vaccine movement tries to convince you that all vaccines are suspect from a pro-life perspective, they are rather co-opting a pro-life position for their own aims rather than being a legitimate part of the pro-life movement.

Like the CMDA doctors above and most pro-life physicians and scientists, and even the Vatican, I believe that using vaccines and medications not developed using fetal cell lines from aborted human beings is strongly preferable whenever possible, and that this is an area where continued economic and moral pressure can encourage pharmaceutical companies and research institutes to pursue alternative means of developing novel treatments to human disease. However, the principles of whole-life pro-life ethics also dictate that a treatment or preventative measure developed in part through material derived from a past harm through abortion, with no potential to cause further harm in this same way but massive potential to prevent loss of life (including unborn human life) is still, clearly, a moral good; a position even Popes have affirmed. In saving the lives of a great many people from a single death that would not have been prevented regardless, we derive the greatest possible moral good from what was an undeniably tragic situation for all involved.

For pro-life persons, accepting a vaccine that was developed from fetal cells collected 50 or 60 years ago makes them neither complicit with nor promoting of a depreciation of human life. But seeking treatments developed using alternative means may send a message to pharmaceutical companies that these issues are indeed dear to their hearts and that their collective will is that these methods in research would become a thing of the past.

And the great news for staunchly Pro-Life people is that not even all effective COVID-19 vaccines use fetal cell lines. Neither the Moderna vaccine nor the Pfizer vaccine, the two that have been recently publicized as 95% effective against COVID-19, used fetal cell lines in development or production. The question of fetal cell lines in medical research and development is an important one; but it is not likely to be an issue when getting vaccinated for COVID-19, assuming you have some degree of freedom in which vaccine you choose.


4:23 “This is what they want… They KNOW this vaccine is going to hurt people or kill people so badly.”

A few things here.

  1. If there is a way to kill people not so badly, please let me know. We could be on the brink of a medical breakthrough here.
  2. Who is “they” anyway?

She jumps around so much in this video that the viewer is left to assume, just like with the MRC-5 discussion, that this last bit is screenshot from the original papers from the vaccine manufacturer; that the people making the vaccine have, in their published study, asked the universe at large to supply them with some sort of computer program or something to help them sort through all the people they intend to maim or kill. We’ve talked before how conspiracy theories rely on this weird paradox where shadowy conspirators are both incredibly clever, subtle, and nigh-invulnerable but also so clumsy as to announce their real plans in such a way that some random person on the internet can piece it all together with a 5 minute video. Pfizer or Moderna publishing “please help us, our excel spreadsheets aren’t robust enough to keep track of all the victims we are after” at the bottom of their research would certainly fall under this phenomenon.

But this isn’t from the vaccine manufacturers. It’s from the Medicines and Healthcare products Regulatory Agency (MHRA), the British counterpart of the FDA. And it isn’t from a research paper, it’s from their contracts division, announcing the technology services they are hoping to contract with as they anticipate the release of these vaccines.

Why would the MHRA or FDA want to track possible adverse reactions to a new vaccine?
Because it’s literally their job.

And why would they anticipate a “high volume” of reported adverse reactions?
Because we are in the middle of a highly politicized, deeply contentious global pandemic; billions of people are going to get these vaccines, and some of them are going to have very mixed feelings about it. Adverse reactions to vaccines range from the common but mild to the serious and extremely rare, but reported or perceived reactions are all over the place. I saw a patient yesterday who believed that his flu shot had caused him to feel fatigued and sore the next day (it had), and also to have six days of diarrhea and loss of taste and smell two weeks later (it hadn’t). He tested positive for COVID-19, the true source of his symptoms. I’ve also had patients who believed their flu shot gave them COVID-19, which is utterly impossible.

Vaccines feel scary; they are sciency and mysterious and they are going into your body, and you are taking someone’s word for it that they are safe and a wise decision. I get that. A new vaccine is even scarier, and a new vaccine for a virus that is deadly, has changed our entire lives over the past year, and is surrounded by a thick haze of misinformation and conspiracy theories is even scarier. Some of the folks getting that vaccine are going to do so, probably to keep those around them safe, only after warring within themselves over it (even I told you I’ve still got some research to do before I’m fully satisfied with the decision). For some of those folks, anything medical that happens to them in the next few months might potentially feel like the negative fallout of that one difficult decision. The point of the MHRA using an AI tool to augment their ability to analyze that data is so that they don’t miss any real adverse reactions hidden in all of that noise; to make sure that if the vaccine is dangerous after all, despite the safety demonstrated in clinical trials, they discover it as quickly as possible. Again, because that’s their job. This is evidence that the people tasked with making sure the vaccines are safe really do take that role seriously; not evidence that someone is planning to hurt you and wasn’t sneaky enough in hiding their intentions.


5:01 “I don’t know how you do it, I’m not technical.”

After watching the same 5 minutes of these folks pointing a shaky phone camera at their computer screen and pulling up various image preview programs and web browsers over and over again while writing this blog post, I can now verify that this is the single most true and reliable statement in the entire video.

It looks like I’m just being cheeky at this point, so I guess it’s time to stop there.

Don’t Be Afraid of COVID-19.

The following is a short repost from social media.


Well, call me triggered.

I’m a Family Medicine Physician, and every day for the past 3 months I’ve seen patients for COVID-19. Every day for 3 months, I’ve told every patient I’ve diagnosed with COVID-19, with the exception of the few I’ve sent directly to the hospital because of the severity of their symptoms, the same three things:

1. Don’t be afraid of COVID-19.

I say this to my patients for a few reasons. First, because I am mostly seeing patients in the outpatient setting, my patients and I have the privilege of emphasizing this point. Second, for many patients who have a mild to moderate severity course of COVID-19, anxiety is a very real issue, and I want to make sure that while they are recovering they are not sitting at home wondering when the virus is going to get them. Most people who get COVID-19 don’t end up in the hospital (as we have been saying since the beginning of the pandemic), even fewer end up in the ICU or die from the virus (as we have been saying since the beginning of the pandemic). The virus is very, very dangerous, but our brains are bad at statistics; just because this is the most dangerous viral pandemic since the Spanish Flu of 1918 doesn’t me that your individual chances of dying are high or that getting deathly ill is a foregone conclusion. If I were mainly seeing very sick patients in the hospital or ICU I wouldn’t be saying this as much; we would be talking more about treatment and response than about the patient’s anxiety about getting sicker, though the latter certainly deserves our time and attention in any clinical setting. When a patient is struggling to breathe, “don’t be afraid” is a theological statement rather than a clinically valid reassurance, and it typically gives way to “I am with you; I am here and I am going to do my absolute best for you.” But in the outpatient setting, talking with patients who are worried about how COVID-19 will affect them and their children and their friends, “don’t be afraid” is an extremely important part of the conversation.

2. If you have the following symptoms, go to the hospital.

As important as “don’t be afraid” is, it is equally as important to talk about what we call emergency and return precautions. Yes, for most people COVID-19 is not deadly; but it is for some, for many in fact, and we do not have any perfect way of predicting who will have a more severe course. For my healthy patients in their 20’s and 30’s, the chances of ending up severely ill are extremely low; yet people who are medically just like them- same age, same paucity of risk factors- have died from the virus. The same for parents who are worried about their children; children are at extremely low risk from COVID-19, yet some children have died from the virus. I can look my young, healthy patient in the eye and honestly tell them I expect them to be fine; but I cannot promise them that they will be, and that’s a vital distinction. So with each and every patient, in addition to reassurance, we talk about what to look out for. Shortness of breath. Chest pain. Severe malaise and fatigue, even syncope; passing out or almost passing out from the toll the virus is taking on your body. We talk about oxygen levels if they happen to have a pulse oximeter at home, and signs of hypoxia if they don’t. We discuss both the reasons they would come back to see me in clinic and the reasons they would skip my clinic and go directly to the Emergency Department instead. With my older patients or patients who have known risk factors (most Americans, in fact, including myself, considering that risk factors for a more severe course of COVID-19 include hypertension, diabetes, obesity, chronic lung disease and other very common ailments), this discussion is even more important, because even though the odds are still in their favor, their ending up in the hospital or dying from COVID-19 is not nearly as unlikely. I want my patients to be free from fear; but I also want them to be equipped with the knowledge they need to make sound choices if their symptoms do worsen.

3. Please keep the virus from spreading to others.

This piece of guidance is no less important than the previous two. If you are healthy and young and your chances of dying from COVID-19 are very low, that’s really wonderful; but self-isolation during your illness is still the responsible, kind, and charitable decision because not everyone is as lucky as you. The case fatality rate of COVID-19 is much higher than even very deadly illnesses like the flu, and it is very, very contagious. With each and every patient I discuss the precautions they can take to keep the virus from spreading to their own family, and of course the responsible social decisions like sheltering at home during their contagious window and alerting their close contacts so they can self quarantine. It’s one thing to tell yourself that you’ve only exposed other people at similarly low risk to yourself, but once you have spread the virus to someone else you have no control of whose grandmother, whose father in poor health, or whose immunocompromised child it spreads to from there. I said before that we are bad at intuitively comprehending statistics; the COVID-19 virus, like most illnesses, is unlikely to cause death to any given individual regardless of risk factors, but is extremely deadly in aggregate; containment is still our best strategy for keeping the 210,000 deaths in our country from doubling or tripling by the end of this pandemic. The reality is that most people get this; most people I talk to understand the need and are concerned about keeping their families and communities safe. But there is a counter-narrative being promoted by some that rejoices in defying all calls for caution, sober mindedness, or charity when it comes to COVID-19, and so the reminder from me, the doctor actually seeing the patient face to face in clinic, becomes that much more important in case my patient has been lured by these cruel and irresponsible ideas.

These are the three pieces of advice, the three categories of discussion that I have with each and every patient. It is time consuming; it appropriately turns what might be a 5-8 minute visit into a 10 or 15 minute visit. It requires careful explanation of statistical and clinical concepts that might be challenging. It is worth it, because the proper way to approach a diagnosis of COVID-19 is with caution on behalf of others and preparedness rather than fear for yourself and your family, and it’s my job as a Physician to equip my patients with the knowledge and tools they need to approach the virus this way, even in the face of anxiety and rampant misinformation.

So when I see someone with a platform like President Trump’s endorse the first point of not being afraid of the virus, follow the second point of going to the hospital when his symptoms escalated and he experienced hypoxia and shortness of breath, and finally utterly disregard and contradict the third point of taking precautions on behalf of others, I am, I think very understandably, upset. Because when a doctor or a nurse survives COVID-19 (and many haven’t), contracted by putting themselves in harm’s way every day and despite taking maximum precautions to keep themselves and those around them safe, they rejoice that they are now able to dive back into the fray, fighting the virus with no less caution but somewhat less stress and anxiety for their own health, knowing that reinfection is very likely a rare occurrence. But when the president contracts COVID-19 by ignoring all precautions and survives it with the help of state of the art high-level hospital care, expensive and experimental treatments, and a private team of doctors and nurses, his first statement after leaving the hospital is one that builds upon his long-standing guidance and example of not taking precautions or acting to protect those around you, despite neither you nor your family and community having anything like the medical access that helped him.

Please keep yourself and others safe. Don’t be afraid of the virus, but please act in charity to those around you by taking reasonable and proven precautions like wearing a mask, maintaining physical distancing, and engaging in sound epidemiological principles like getting tested if you are ill, self-quarantining if you are exposed, and honestly and proactively participating in contact tracing if you are diagnosed.


Edit #1:
I will go ahead and anticipate a couple of objections to this post. First, some people are going to claim that the facts I’ve shared here are inaccurate; that the ‘CDC admitted’ that only 6% of the deaths were actually from COVID-19, or that the fatality rate is actually lower than the flu, or some such nonsense. For people who still believe these pieces of COVID-19 misinformation, there is no shortage of good explanations and rebuttals available on the internet and I suggest finding and reading one. For people who don’t mind a long and mediocre rebuttal over a good one, I’ve written a few myself over at tjwebbmd.com.

Second, some people are going to look at this tweet from the president and say, “but TJ, he isn’t discouraging caution or telling people to take COVID-19 less seriously! He just said don’t let it dominate your life, that could mean lots of things!” To those people I will say, along with Doctor Archibald from Veggie Tales, “Stop being so silly!”

When I tell my patient “don’t be afraid” after reviewing their vital signs, asking about their symptoms, carefully examining them and listening to their heart and lungs, and carefully talking through emergency precautions and transmission control measures, they are absolutely not confused about what I mean. And nobody in America is confused about what the president means when, after months of promoting misinformation, minimizing the pandemic, shirking transmission control guidelines even to the point of endangering his secret service and staff during his own illness, refusing to wear a mask (and then only wearing one intermittently and with a wink at mask truthers when he does), he then says to ‘not let it dominate your life’. And nobody will be surprised when the ongoing unwillingness of our national leadership to take the pandemic seriously, and encouraging others to do likewise, results in more cases, more severe illnesses (and associated suffering and medical debt), and more deaths.


Edit #2:
On the same day that I posted a short essay titled “Don’t Be Afraid of COVID-19”, Dr. Emily Smith, Your Friendly Neighborhood Epidemiologist, posted a short essay saying that Yes, We Should Be Afraid of It. Now, Dr. Smith is so much smarter than me that this would normally be enough to make me immediately delete my post; but thankfully, it turns out we are saying essentially the same thing, despite the seemingly contradictory essay titles. To understand what Dr. Smith and I mean when we say you should/shouldn’t be afraid of COVID-19, go and read her essay where she discusses the difference between unhealthy fear and wisdom, the latter being something our national response to this very deadly and dangerous virus has been sorely lacking.

𝐒𝐨, 𝐰𝐡𝐲 𝐬𝐡𝐨𝐮𝐥𝐝 𝐰𝐞 𝐛𝐞 𝐚𝐟𝐫𝐚𝐢𝐝 𝐨𝐟 𝐂𝐎𝐕𝐈𝐃? 𝐁𝐞𝐜𝐚𝐮𝐬𝐞 𝐭𝐡𝐞 𝐬𝐜𝐢𝐞𝐧𝐜𝐞 𝐭𝐞𝐥𝐥𝐬 𝐮𝐬 𝐰𝐞 𝐬𝐡𝐨𝐮𝐥𝐝. 𝐋𝐞𝐭’𝐬 𝐝𝐞𝐟𝐢𝐧𝐞 𝐰𝐡𝐚𝐭 𝐭𝐡𝐚𝐭 𝐢𝐬 𝐟𝐢𝐫𝐬𝐭 𝐭𝐡𝐨𝐮𝐠𝐡. 𝐓𝐡𝐞𝐫𝐞 𝐢𝐬 𝐚 𝐝𝐢𝐟𝐟𝐞𝐫𝐞𝐧𝐜𝐞 𝐢𝐧 𝐰𝐢𝐬𝐞, 𝐡𝐞𝐚𝐥𝐭𝐡𝐲 𝐟𝐞𝐚𝐫 𝐚𝐧𝐝 𝐮𝐧𝐡𝐞𝐚𝐥𝐭𝐡𝐲, 𝐝𝐞𝐛𝐢𝐥𝐢𝐭𝐚𝐭𝐢𝐧𝐠 𝐟𝐞𝐚𝐫. 𝐓𝐡𝐞𝐫𝐞 𝐢𝐬 𝐚 𝐝𝐢𝐟𝐟𝐞𝐫𝐞𝐧𝐜𝐞 𝐢𝐧 𝐫𝐞𝐜𝐤𝐥𝐞𝐬𝐬 𝐛𝐞𝐡𝐚𝐯𝐢𝐨𝐫 𝐚𝐧𝐝 𝐜𝐚𝐮𝐭𝐢𝐨𝐮𝐬 𝐰𝐢𝐬𝐝𝐨𝐦. 𝐈𝐭’𝐬 𝐭𝐡𝐞 𝐫𝐞𝐚𝐬𝐨𝐧 𝐰𝐡𝐲 𝐰𝐞 𝐭𝐞𝐥𝐥 𝐨𝐮𝐫 𝐜𝐡𝐢𝐥𝐝𝐫𝐞𝐧 𝐧𝐨𝐭 𝐭𝐨 𝐭𝐨𝐮𝐜𝐡 𝐚 𝐡𝐨𝐭 𝐬𝐭𝐨𝐯𝐞 – 𝐭𝐡𝐚𝐭’𝐬 𝐧𝐨𝐭 𝐮𝐧𝐡𝐞𝐚𝐥𝐭𝐡𝐲 𝐟𝐞𝐚𝐫, 𝐢𝐭 𝐢𝐬 𝐰𝐢𝐬𝐝𝐨𝐦.

Dr. Emily Smith, PhD, MSPH

6%

One thing that has become predicable throughout the SARS-CoV-2 pandemic is that any story, any recommendation, any development, or any piece of data that can be interpreted as meaning that the danger of COVID-19 has been inflated, misrepresented, or exaggerated by medical experts will be interpreted that way by a large percentage of our population. This is no longer surprising, but honestly it’s also completely understandable. We all hate this pandemic. Whether you are working on the front lines in clinic or in the trenches at the hospital treating COVID-19 every day, whether the virus has harmed or killed a friend or family member, whether your job or business has been affected, or even if you just really miss people, we are all ready for this to be over. The hard path forward involves biomedical research, redoubling mitigation efforts that we are all exhausted of, and at this point, modifying holiday plans and preparing to deal with the quagmire of cascading clinical probabilities that are required to fight the virus in the midst of cold and flu season. But the quicker and easier path to getting rid of this hated virus is undoubtedly to just choose not to believe in it at all. And while this “just don’t believe in it” approach is likely to be about as effective as it has been for any of the other problems I’ve tried it for (taxes, bills, excess carbs), I am sympathetic to the appeal of it. If the pandemic has not affected you directly- or maybe even if it has- it may be very tempting indeed to buy into a video like Plandemic, which tells you that the whole thing is just a government conspiracy, or into the America’s Frontline Doctors‘ video which tells you that there is already an easy and inexpensive cure if you just drive to the see the right doctor. Life can be normal again right now, these sources say; all of your hopes are true and all of your caution and privations can finally come to an end. I’m not saying it’s right, I’m just saying I get it.

But what has been surprising- and consistently surprising, to me at least- is which wild facts people will latch onto to create these false narratives. Before today, I would never have expected this paragraph from the CDC’s weekly updates by select demographic and geographic characteristics to be the next cause of viral misinformation:

Yet here we are.

What is the claim being made?

If I chose to end this blog after today, I would feel I had really come full circle; my very first blog post was about the myth, popular late in March (and persistent even today), that doctors were lying on death certificates to make the virus seem more dangerous than it really was. Today’s myth is that analyzing the diagnostic codes on death certificates –those incorruptible sources of reliable data- reveals that the virus isn’t actually very dangerous at all, and the CDC has just admitted to it. Bypassing the irony that this later misinformation is being circulated by exactly the same people who have been sharing the first for months, we can spend today’s blog post (48 hours late as usual, this time because our internet was out all day yesterday!) analyzing these claims. They seem to have taken two forms.

The first, and more moderate, is to claim (or at least strongly imply) that because 94% of deaths from COVID-19 also had other diagnostic codes listed on the death certificate, it means that people without ‘underlying medical conditions’ are not actually at a very high risk of dying from the virus. And in one sense this is true, even if this new data from the CDC doesn’t actually really have anything to do with that. Your Local Epidemiologist says this better and more succinctly than I can:

And she’s absolutely right; we have been saying this from early in the pandemic. But not just saying it; thinking it and believing it, too. Every decision I make as a physician, from admitting someone for COVID-19 to starting or stopping a medication, referring them to a specialist, or even recommending exercise or lifestyle changes has to take into account their medical history (and a host of other factors). While there are some symptoms we can warn everyone about, the counseling and support we provide for patients seeking evaluation and treatment of COVID-19 has a lot to do with their individual risks from the virus and how it might manifest in their lives based on their age and other medical conditions. This 6% misinformation became viral just yesterday, yet if you asked any doctor last week they would have already told you that the younger and healthier you are the less likely you are to end up in the hospital or die from COVID-19, and the more medical complications you have the more concerned they are about you having the virus. I know because this is exactly what I was saying to people in clinic last week, and the week before that, and the week before that. Yes, many young and otherwise healthy people have died tragically and shockingly from complications of the virus; but this is still a rare occurrence on the whole compared to the number of young, healthy people who have had the virus. When I counsel people at low risk of complications from COVID-19, we of course talk about the signs and symptoms they should watch for that would trigger a trip to the ER, like chest pain and shortness of breath; but I also want to make sure they aren’t sitting at home, anxiously wondering when the virus is ‘going to get them’. I want them self-isolating; I don’t want them to be afraid. But this relative reassurance towards the young and healthy is actually undercut ever so slightly when you combine headlines like these with the actual data being reported from the CDC, which I’ve included below.

When you look at the other diagnostic codes listed in the table above, you will notice that codes like E78.2 and I10 are listed; high cholesterol and high blood pressure, respectively, both conditions I’ve been diagnosed with in the past (and probably still have, if I would ever go get a check-up. Doctors really do make the worst patients). At 35 and having never spent a night in the hospital as a patient in my life, nobody would call me high risk for complications of COVID-19. In fact, if I contracted COVID-19 and died of it this week, two things would happen. First, my blog would probably get a lot more hits for a couple of days (and this paragraph in particular would seem very bitterly ironic). But second, I would be held up as an example of how being young and in relatively good health is not a perfect guarantee of safety from the virus. Yet I would be a part of the 94%, not the 6%.

The reality is that in saying “94% of COVID-19 deaths had underlying conditions,” these stories are adding nothing to and are in fact dumbing down the more sophisticated knowledge we already have, and share with our patients daily, of the most important risk factors and conditions that predispose someone to COVID-19 being a likely threat to them. They are meant to lure you into a false sense of security, because it’s so easy to think they mean somebody else besides you (even if you do in fact have some of those diagnoses, like I do) and a relatively small group of people. But when I look at the chart, I realize that even I fall into that group with “2 or 3 underlying medical conditions” that they are saying 94% of the COVID-19 deaths occurred in; in fact, most Americans do. And when a statistic includes me, privileged to be in pretty good health as I am, but also my patient battling metastatic kidney cancer and my patient suffering from both CHF and COPD, maybe it just isn’t a very useful statistic in the first place.

But the more dishonest and blatantly ridiculous claim, which has absolutely no justification, is to say that only the 6% of deaths with just COVID-19 listed on the death certificate actually count as COVID-19 deaths. Take this one Facebook poster who has been widely shared, who had the gall to take this to the next step and “calculate” that only 9,210 people had “actually died from Covid.” Probably because she was willing to put a number on the deaths, this post has been shared 21,000 times on Facebook; but it’s hard to believe that someone with a doctorate degree, any doctorate degree, could have such little grasp on basic statistics.

No, No, No.

This post entirely misrepresents everything within our complex understanding of medicine regarding the impact of medical comorbidities, the myriad causes and steps leading to death in COVID-19 or any other illness, and even the very process of completing a death certificate. In her estimation, Dr. Hesse is saying that a diagnostic code on the death certificate other than COVID-19, literally any other code, is sufficient evidence that the patient did not die from COVID-19. This is not only preposterous and dishonest but also just plain silly. We are going to explore these issues more thoroughly in the next section, but briefly, just look at the chart above and begin googling ICD-10 diagnostic codes for yourself to test the logic of her interpretation. Yes, I can absolutely believe that some of the patients whose death certificates reflect both COVID-19 and also diagnosis code C71, Malignant neoplasm of brain, may actually have died from the brain cancer and were only found to have the virus incidentally. We can’t tell from the data if that did in fact happen, or how many patients might have such a presentation. But with COVID-19 being an acute illness and brain cancer being a chronic illness, the disease and treatment of which also predisposes you to infectious illnesses, it is at least as reasonable to assume that the majority of patients who died from “COVID-19 and brain cancer” actually died from COVID-19, which they were more vulnerable to because of their pre-existing brain cancer.

But Dr. Hesse’s assertion that only the 9,210 “COVID-19 only” deaths should count also has to stand up to scenarios like, say, any hypothetical patient who was certified as dying with COVID-19 and R09.3, Abnormal sputum, or COVID-19 and N20.0, Kidney stones. Again, we can’t tell from this data whether any such patients with only those codes exists; but neither can Dr. Hesse, and for her argument to be valid, each and every possible diagnostic code included in the chart above would, if added to a COVID-19 death certificate, nullify COVID-19 as a primary or contributing cause of death. That is what she is saying, and it is obviously ridiculous. What this error betrays is a complete misunderstanding, whether intentional or accidental I know not, of how death certificates are completed and the information they are meant to capture. Even though it means a longer essay, I do think it’s worth taking the time to revisit this again.


What information do we include in a death certificate?

Once you have been trained to complete death certificates (and have actually done it), this “6%” argument is not even momentarily tempting or convincing. I know what you are thinking; “but TJ, we haven’t been trained to complete death certificates, so you are asking us to trust you with this area of specialized knowledge we don’t have access to.” Well good news reader, the Texas Department of Health and Human Services, DSHS, has got you covered. If you want to understand this 6% statistic from the CDC, I highly recommend that you watch from 1:44 to 3:08 of this video.

Sorry, the secret tutorial video they released after COVID-19 is password protected.
Also, that was a joke.

Obviously each state will have its own version of this software, but they are all intended to convey the same information; the death certificate is not a high-stakes multiple choice interrogation asking the doctor, “What disease caused the patient’s death? Was it COVID-19 or heart failure? ANSWER THE QUESTION!” Rather it is an opportunity to distill the sequence of events leading to the patient’s death, recorded in greater detail in the medical record, into a structured narrative that explains how they died. When a doctor includes coronary artery disease on the death certificate, they are not making a political statement or a value judgement, but rather an honest reflection of the part this disease played in the patient’s death based on their medical knowledge and their intimate understanding of the progression of illness as the patient’s treating physician. And it is exactly the same with COVID-19. Moreover, this is not something that the physician derives a financial benefit from or an opportunity to defend the medical care the patient received (in fact, I have listed iatrogenic injury on the death certificate when I felt that my own mistake or that of another medical professional contributed in some way to the death of the patient), but rather something that is important for public health information and, in various ways, important to the family of the deceased.

Briefly, I’d like us to complete a medical certification for a death certificate together, again using my hypothetical death from COVID-19 as an example. In this scenario, let’s say that I get sick with cough and loss of taste and smell this week and am diagnosed with COVID-19. Around day 10 of my symptoms I begin to experience chest pain and shortness of breath, and I go to the ER. There I am found to be hypoxic and my chest x-ray shows bilateral peripheral consolidation consistent with ARDS. they begin to treat me with dexamethasone, remdesivir, and oxygen. Over the next few days my respiratory distress increases and, even allowing some permissive hypoxia in order to avoid intubation, the doctors simply cannot keep my oxygen level within safe parameters; they make the difficult decision to intubate me and put me on a ventilator. I am ventilated in prone positioning using the latest and best evidence-based ARDS/COVID-19 ventilation strategies from the genius doctors over at EmCrit and PulmCrit. Unfortunately, I continue to become progressively, severely hypoxic, and eventually suffer cardiopulmonary arrest. Resuscitation is attempted but ultimately efforts to revive me prove futile; the lungs are not compliant, effective ventilation still cannot be achieved, and return of spontaneous circulation is impossible. I’d make a joke about making the life insurance check out to my wife, etc. at this point, but honestly when I reflect on how many people have died from this sequence of events over the past six months, it’s pretty sobering. I’ve made myself sad just now thinking about all of the families that have lost a mother, father, sibling or grandparent in exactly this way.

Once I’ve died, the doctor treating me will have to record it in a death certificate; we can use the Texas system, since it’s what I’m familiar with.

Here in Part I we list the immediate cause of death. In my case, it’s going to be cardiac arrest. Because this is technically the immediate cause of death in every death except those caused by brain death, some doctors would leave this out. Since resuscitation efforts were made and the arrest was a distinct medical event, I would probably include it, but an argument could be made either way. Next we need to describe the events that led to this. I’m not going to include respiratory arrest because I would feel it was a bit redundant, and besides, I was already not breathing on my own when the cardiac arrest happened since I was on a ventilator. Instead, I would say the arrest was due to respiratory failure. The respiratory failure was due to ARDS, Adult Respiratory Distress Syndrome, and you could make a case here for including viral pneumonia as well. Finally, the ultimate cause of this cascade of complications is my infection with COVID-19.

Next I would need to list any other contributing factors in Part II, and here is where the quandary usually comes in, because now I have to decide whether my high blood pressure and high cholesterol belongs in Part II, “other significant conditions contributing to death but not resulting in the underlying cause,” or in Part I further down in the chain of events. In this case it’s easy; my high blood pressure is a significant medical issue and made me at higher risk from the virus, so it belongs in Part II; but it didn’t cause me to get COVID-19, so it doesn’t belong in Part I. My chronic right shoulder pain didn’t contribute at all and gets left off the death certificate. These decisions aren’t always easy; sometimes a condition did lead directly to death in chain of events that are causative narratively even if not pathophysiologically; for instance a patient who is hospitalized for a hip fracture and then develops sepsis from a central line. The hip fracture didn’t cause the infection that kill them, but it was a direct part of chain of events. But what about the vertigo that caused the fall that caused the hip fracture; does that belong in Part I or Part II? I have a physician friend who works in hospice care who completes death certificates almost every day (I have completed maybe a dozen); he says this is typically the hardest decision point when it comes to completing a death certificate, deciding what was really a cause and what was ‘only’ a contributing factor. Still, it’s straight forward enough in my hypothetical case, and we can finalize my death certificate as follows:

Cause of Death – Part I:
IMMEDIATE CAUSE
a. Cardiac Arrest.
DUE TO
b. Respiratory Failure.
DUE TO
c. Adult Respiratory Distress Syndrome.
DUE TO
d. COVID-19.

Cause of Death – Part II
-Hypertension, Hyperlipidemia

So, for young, relatively healthy me who died from the most stereotyped and straightforward case of severe COVID-19 I can conceive of, we have 5 other diagnostic codes listed on the death certificate between direct cause conditions and contributing conditions. Contrast that to what a Texas death certification with only the diagnostic code for COVID-19 -the only types of death certificates Dr. Hesse believes count as COVID-19 deaths- would have to look like:

Cause of Death – Part I:
IMMEDIATE CAUSE
a. COVID-19
DUE TO
b. ________________________
DUE TO
c. ________________________
DUE TO
d. ________________________

Cause of Death – Part II
________________________

My friend, the hospice doctor, has completed over 500 death certificates (a conservative estimate) since finishing residency a few years ago. He says he has included just one diagnostic code alone maybe twice. What Dr. Hesse sees as the ‘real’ COVID-19 deaths, these 9,210 death certificates without any other documented diagnoses, I see as an anomaly; I am forced to ask myself how that many death certificates were complete in what I consider to be such an incomplete and insufficient manner. I have two theories, aside from some doctors simply not giving the proper attention to the task that they should have or not understanding the importance of completing the death certificate thoroughly. One is that some of the doctors who have been taking care of patients in this pandemic simply might not be familiar with how to complete a death certificate. This pandemic has brought doctors out of retirement and graduated 4th year medical students months early to shore up the frontlines; surely some just haven’t had even the 5 minutes of training from the video above and don’t know how to complete the forms properly; frankly it’s a low priority in their training right now. But second, some of the death certificates for COVID-19 patients have been completed by doctors who were incredibly overwhelmed. When we consider places like New York City, where doctors and nurses were dropping from exhaustion during shifts and barely had time to document at all, and were seeing multiple deaths per shift, each and every shift for weeks, it is reasonable to expect that some of those doctors no longer felt that taking the extra time to document a complete death certificate series of events was a priority. I can’t argue with them; it wouldn’t be. As important as the death certificate is to the patient’s family and for public health purposes, it is a low priority in a crisis when your time would otherwise be spent taking care of living patients or trying to shore up your own physical and mental reserves. If this is the case, the doctors who typed “COVID-19” and submitted the death certificates probably had no idea that such an action would contribute to even more dangerous medical misinformation threatening to extend the pandemic a few months later; a lesson in unintended consequences.


So what do all of these other codes mean?

There are many ways to interpret the diagnostic codes listed in the comorbidities table from the CDC’s latest update. We could spend hours in speculation, wild surmises, or careful parsing and analysis (if you’re a nerd) to try to recreate the narratives of the deaths represented by this data. The amount of analyzing, explaining, and even guesswork we could devote to this is endless. But briefly, I’d like to explain how to understand the majority of these diagnostic codes and the diseases, conditions, or symptoms they represent by considering them in three large categories.

Other ways of describing COVID-19.
The first category that these “other diagnostic codes” fit into is simply other ways of describing the symptoms and complications of COVID-19 itself. If I treated you in the hospital for a CVA (cerebrovascular accident; a stroke), but I also added on diagnosis codes for right arm paralysis and slurred speech, you wouldn’t review the medical record and say, “see, I wasn’t treated for stroke after all! They were treating me for right arm paralysis and slurred speech and just added that ‘stroke’ code on because Dr. Webb probably gets some sort of kickback for it.” The paralysis and the slurred speech delineate more specifically which stroke symptoms you experienced; their inclusion creates a more complete record of your presentation and treatment. In fact, it isn’t at all uncommon to have multiple diagnostic codes that actually say the same thing, due to different doctors and different departments interacting with your medical chart and, again, for the sake of completeness. If I have already added “slurred speech” to your chart, the neurologist later adding ‘expressive aphasia’ doesn’t actually add anything to your medical record (except a little reminder that she’s smarter than me); but it might be more appropriate to document it this way for the referral to speech therapy she is ordering for after your discharge, or to have this diagnostic code associated with the MRI. The synonymous diagnostic codes are repetitive, but it doesn’t necessarily follow that they are redundant

Now apply this logic to death certificates and COVID-19. We’ve already discussed that most doctors would like to be as complete and thorough as possible with death certificates and that it is somewhat odd to list only one diagnostic code without providing a fuller narrative. When we see diagnostic codes like J96 (respiratory failure; 54,803 cases), R09.2 and I46 (respiratory and cardiac arrest, 3,282 and 20,210 cases respectively), and J12.9 (viral pneumonia, unknown number of cases, but contained within the “Influenza and Pneumonia” group), all the doctor is doing is using additional diagnostic codes to clarify the events affecting the patient’s lungs that led to death. In fact, it would not be inappropriate to include all four of these codes for many COVID-19 deaths, because the natural history of viral pneumonia due to COVID-19 leading to respiratory failure and eventual arrest is unfortunately far too common. The same applies to codes like A40 and A41, Sepsis (14,053), which is not even a diagnosis in itself but a syndrome describing the body’s systemic reaction to infection, and many of the “all other conditions” codes like R09.1, pleuritic chest pain and R09.0, hypoxemia.

But the most obvious example is J80, Adult Respiratory Distress Syndrome (21,899 cases). This is literally the severe respiratory syndrome caused by COVID-19, yet people like Dr. Hesse who claim to have evaluated this data carefully did not include these deaths in their “real” COVID-19 death count. To be clear, if a patient’s death certificate listed only COVID-19 and ARDS, these medical misinformation hucksters wouldn’t count them; that patient died of ARDS, they would say, not COVID-19. It’s like saying someone didn’t die from falling off a plane without a parachute, they died from the landing. It’s the bad dad joke of medical misinformation and the clearest piece of evidence we have that those originating this narrative are either extremely unqualified to interpret this information… Or else are not in earnest with their conclusions, but instead are pushing misinformation intentionally from what motivations and purposes I cannot say. 

Conditions that really do make COVID-19 more dangerous.
Much of the work I have seen refuting the “6%” misinformation so far has focused on the concept of comorbid conditions or medical comorbidities. Simply stated, these are diseases or conditions that make us more susceptible to other disease processes or more likely to have complications from them. Some of these diseases are also extremely dangerous in themselves, and others are primarily dangerous because of their role in predisposing to other conditions. A good example of the former is Congestive Heart Failure (I50, 10,562 cases). This is an extremely dangerous, chronic disease that has a fairly low 5 year survivability from the date of diagnosis (average of 62%, but as low as 48%, in African American men because of healthcare disparities). You can absolutely die of complications from heart failure, but it also increases your risk for many other diseases and infections. It is both a primary cause of death and a comorbidity, and without a more detailed dataset or an intimate understanding of each case, we cannot possibly say how many of the 10,562 people who died with both COVID-19 and heart failure died from heart failure complicated by COVID-19, from COVID-19 which they were more vulnerable to because of heart failure, or from a more complex clinical picture that involved heart failure, COVID-19, and other contributing factors. But is this information going to change anything for us? The medical misinformation spreaders want you to believe that all 10,562 of the people who died with both heart failure and COVID-19 died at the time they would have from their heart failure with or without a viral pandemic. They want you to believe this based on nothing other than the fact that it fits a more comfortable narrative; but it flies in the face of what we are hearing from doctors, nurses, family members, and patients of those with heart failure about the way that COVID-19 affects those who are already suffering from these types of chronic illnesses.

Other examples in this category include renal failure (N17-N19, 13,693 cases), COPD and other chronic respiratory disease (J40-J47, 13,780 cases), and quite a few of the “other conditions and causes” listed, such as N04 (Nephrotic Syndrome), L93 (Systemic Lupus), and of course B20 (HIV), just to name a few. The people spreading this misinformation are putting the people with these illnesses at greater risk, specifically, by either pretending that COVID-19 is not a threat to them (the “only 6% count” crowd) or by seeming to claim, callously, that caution as a society isn’t warranted on their behalf (the “94% had comorbidities” crowd).

But within this category we also include diseases that are not likely to kill you on their own, and which would have almost certainly been included on the death certificate due to the physician’s conviction that they made the patient more susceptible and less able to resist the complications of their COVID-19 infection. These include Obesity (E65-E68, 5,614 cases), Alzheimer’s disease (5,608 cases), and of course other types of dementia (F01 and F03, 18,497 cases). Do we really believe that a patient with COVID-19 and obesity listed as their causes of death have died from obesity, and that their having COVID-19 was a coincidence? That is not something that happens. Dementia in particular is an interesting conundrum, because with COVID-19 harming so many people in nursing homes it is potentially not only a physical risk factor, which it most certainly is, but also an epidemiological risk factor; many doctors might include a patient’s reason for living in an assisted living facility, such as dementia or disability, within the death certificate as part of the narrative of how the patient came to be exposed to COVID-19, the same way we might list arthritis on the death certificate for a patient who suffered a heart attack during physical therapy. Again, these are not competing diagnoses that draw responsibility for the death away from COVID-19, but rather a fuller picture (that is, as full as can be told with diagnostic codes alone outside of the full medical record) of the patient’s story leading up to their death.

Finally, a few categories of disease deserve some extra discussion, and those are diseases that could cause death all on their own but almost certainly didn’t for the patients reflected in these death certificates. Hypertension (I10-I15, 35,272 cases) is incredibly common and usually leads to longterm organ damage rather than acute crises, but can present with severely elevated pressures that lead to stroke or another vascular event. However, this would typically be indicated with the diagnosis code I16, hypertensive crisis or I16.1, hypertensive emergency, which are specifically not included in the diagnostic codes for the hypertension group in this table. It is possible that this is just a common coding error on death certificates, but I doubt it; if the physician believed that the severity of the patient’s hypertensive crisis led directly to their death, they would likely take pains to emphasize this on the death certificate; applying a code for essential or secondary hypertension instead suggests that they regarded it as a comorbidity or at most a contributing factor. Diabetes (E10-E14, 25,936 case) is another example. Diabetic Ketoacidosis (DKA) is a severe metabolic disorder that often requires ICU level care; but this is primarily due to how labor intensive it is to treat, and the mortality rate remains low. These 25,936 people who had both COVID-19 and diabetes did not die from DKA, which accounts for less than 2,500 deaths annually. Instead, both diabetes and hypertension, just like dementia and obesity, are comorbid conditions that make the patient more susceptible to and likely to experience worse outcomes from other diseases, and as such their role in this list of additional diagnostic codes on COVID-19 death certificates is the same as their role in death certificates for patients who die from stroke, heart disease, and influenza; yet no-one is claiming that because a patient had high blood pressure and diabetes, their death from the flu didn’t count.

Conditions that might have nothing to do with COVID-19 and might have actually caused the patient’s death (maybe)
Finally, we have conditions that, based on the diagnosis code alone, we know to be incredibly dangerous and also to be common causes of death. Some of these, like certain cancers (C00-C97, 7,415 cases plus some of the ‘all other conditions’ group) we can treat similarly to heart failure or COPD; they may predispose you to COVID-19 or raise the risk that your COVID-19 course of illness will be severe, or they may be immediately dangerous in and of themselves and be worsened by COVID-19 or not. If someone wants to ask how many of the thousands of deaths that included a cancer diagnosis were actually caused or hastened by COVID-19, and how many just happened have the virus during the days leading up to to death from a terminal malignancy, I think it’s a fair enough question; though from what I’ve heard from friends who provide hospital and hospice care, the former does seem to be very common. In the latter cases, if such cases are at all common, the additional suffering from COVID-19 must be felt in other ways; in the barriers it places to those individuals being surrounded by family and friends as much as possible during their final days. 

We could legitimately ask the same question for some other diagnoses on the list; heart attacks and cardiac arrhythmias (18,103 and 9,812 cases respectively), pulmonary embolism (I26, contained in the 8,743 “other disease of the circulatory system”), and strokes (I60-I69, 7,653 cases) are all very deadly on their own. However, unlike with cancer, which has no known or proposed causal relationship with COVID-19 aside from immunocompromise, the virus is known to cause a hypercoagulable state that has caused all of the above pathologies. How many of the deaths that involved these diagnostic codes were due to these conditions and how many were in turn due to COVID-19 is known only to the doctors, nurses, and family members that were involved in their care. Attempts to make absolute statements that these deaths simply were not caused by COVID-19 (despite the doctor writing the death certificate feeling they the virus did in fact contribute to the death) because another dangerous disease was also involved are based entirely on a desire to minimize the danger of the virus, and not on any interpretation or analysis that can be legitimately conducted from this set of data.

My friend, an ER Doc in New York

The final set of diagnostic codes we need to look at are the 5,133 included in COVID-19 death certificates under the category “Intentional and unintentional injury, poisoning and other events.” We don’t know which codes specifically show up in these death certificates, but much like the other ‘other’ catch-all categories it contains diagnoses ranging from S00.37XA, Other superficial bite of nose (a diagnosed I received today courtesy of my 16 month old), to X95.9, Assault by firearm. What is going on here? Much like the “other” diagnostic codes we talked about above, there may be any number of reasons that some of these codes might be on a COVID-19 death certificate. Some may be complications that arose in the hospital, such as SO6.9, Intracranial injury, when a COVID-19 patient experienced a syncopal episode and hit their head. Some may be part of a historical narrative, for instance a patient who experienced a prolonged hospitalization following a V03.10XA, Motor vehicle collision injuring a pedestrian, which ultimately ended when they died from respiratory failure due to COVID-19 contracted in the hospital. Again, without access to the actual death certificates, medical records, and medical staff who treated these patients we simply do not know what circumstances or patient history necessitated the physician to include both COVID-19 specific diagnostic codes and codes for accidents or intentional and accidental injuries in the same death certificate; but it absolutely does not stretch the bounds of credulity to believe that such circumstances do indeed occur.

Nevertheless, I want to cede this point to the conspiracy theorists, if only for just a moment. What if we do “admit” (as ridiculous as it is, and with apologies to the families of the individual people whom these death certificates represent) that each and every death certificate listing one or more of these accidental and non-accidental injuries represents a patient who died from some horrible accident, with COVID-19 just tacked on but clinically silent? You see, since the beginning of the pandemic the conspiracy theorists have been telling us, with no evidence, that “if somebody gets hit by a car they are calling it a COVID-19 death” and “if someone gets shot, they call it COVID-19 to inflate the numbers.” This data, from actual death certificates, now shows that the maximum possible number of such falsified death certificates tacking on COVID-19 to an accidental death is 5,133; compared to 183,000 deaths from COVID-19 and an estimated 80,000 total deaths from accidents in that same time frame. And again, that’s assuming that no other possible explanation exists for those “other accidental and non-accidental injuries” contributing to a person’s death from COVID-19.


Conclusion

Many of the diagnostic codes listed don’t fit easily into just one of the above categories, because we just don’t know enough about the history of the people whose battles with and deaths from COVID-19 are represented here. We don’t know, from this data set, whether the physician completing the death certificate was indicating a new stroke as a primary cause of death, or an stroke that lead to a rehab stay where the patient contracted COVID-19. We don’t know whether diabetes was listed because it was poorly controlled and played a major role in the hospitalization, or whether it was well controlled and was only included because that physician knew that diabetes is a risk factor for the patient’s unfortunate bad outcome from COVID-19 infection. We also have no idea what to do with codes that are so benign in themselves that they don’t really seem to have a place on a death certificate at all, yet the physician clearly regarded as an important part of the patient’s history leading up to their death.

But what we do know, with certainty, is that this new data released from the CDC does not mean. If you’ll spend just a few minutes really looking at the data, at the ages and the conditions mentioned, you will realized that it cannot mean that 94% of the people who have died from COVID-19 were incredibly sick, incredibly frail, and incredibly old people with many other diseases who would have died soon anyway; that argument is as bankrupt in its analysis of this data set as it is ugly in its callousness. That is not what the CDC means when they tell us that 94% of death certificates listed ‘more than one diagnostic code’ or contributing factor, as we’ve clearly demonstrated above. And even if it were (and it’s not), it would not somehow mean that the lives lost to COVID-19 were less valuable; those who see this false idea that 172,000 of the 183,000 people who have died from COVID-19 were sick already as a compelling reason to stop mitigation efforts need to carefully consider whether their only motivation for taking caution has been their own personal health and safety this entire time… And then try to understand why that has not been the sole or primary motive for the rest of us; that the safety of those around us, including the medically vulnerable, is actually sufficient reason for some inconvenience and even sacrifice on my part.

And we also know with certainty that no real scientist, statistician, epidemiologist, or physician, and certainly no one who actually treats patients on their death beds and then completes death certificates to capture the complex and detailed medical events of their final days would ever believe the idea that the 6% of death certificates with only COVID-19 listed as a cause of death represents the “real” death told of this horrible virus; at least not without some herculean effort of intellectual dishonesty and self-deception.

Please keep comparing COVID-19 to Human Trafficking (Part 2).


Trigger warning for human trafficking, rape and sexual assault, sexual abuse of children, and exploitation.


The big question we didn’t address yesterday (well, two days ago now) is whether the people making these comparisons between COVID-19 and cancer or diabetes are doing so because they truly care about those medical problems, like the nurses and doctors who treat them and the patients and their family members who are affected by them every day do, or just because they happen to find them convenient comparisons for minimizing or dismissing concerns about the pandemic. And while using a lifelong illness that causes real suffering like stroke or cancer for rhetorical purposes is a bit calloused, I can’t say I find it truly morally repugnant the way I do when the same thing is done, if indeed it has been done, with human trafficking and modern day slavery. Recently, I have started seeing a few different memes/images shared on social media making just such a comparison; but I believe they have very different degrees of merit and, I’m afraid, might be coming from very different places in terms of degree of actual sincere concern about the very real problem of modern day slavery.

Human trafficking is a truly evil industry. Some of the people who have shared these memes have quoted conservative estimates of 25 million slaves worldwide today; I believe the ILO estimates that are closer to 40.3 million, though even that was back in 2016 and the number is likely to be even higher now. This includes 5 million people, 99% of whom are women and girls, who are victims of sex trafficking and forced sexual exploitation. In addition to being robbed of their freedom and dignity, the men and women affected by modern day slavery suffer extensive medical and psychological problems that can last a lifetime, and many are subjected to nearly constant physical, sexual, and psychological violence, torture, and dehumanization. It is one of the worst offenses against human beings occurring today, and its cost in human lives and suffering is incalculable. In one sense, there can be no comparison between human trafficking and COVID-19, because even the suffering from a respiratory virus that claims your life would be preferable to most of us compared to what is endured by victims of modern day slavery.

I first heard about modern day slavery from my friend Michelle Palmer, co-founder of the blog Tuesday Justice, back in 2008, my first year of medical school. That next year we became involved in grassroots organizations in Denver involved in raising awareness about human trafficking and modern slavery both in the United States and internationally. In medical school I hosted film screenings, attended academic conferences on human trafficking and training with the FBI and GEMS on commercial sexual exploitation of children (CSEC), and once even sat next to the author of The Vagina Monologues on a committee focused on professional collaboration to fight human trafficking in the city and state. When we moved to Waco I got involved with Unbound and eventually became one of their medical professional trainers. Over the last few years myself and one of my clinic partners have trained hundreds of physicians, nurses, other healthcare professionals, and Texas medical students to use their calling in medicine to recognize the signs of human trafficking and help address the unique medical and support needs of survivors, in addition to treating survivors of human trafficking and modern day slavery in our own clinic.

Last week, that partner and I both spent a significant number of hours in full PPE, in the 90-100 degree heat, evaluating, testing, and counseling patients for COVID-19. In 2 weeks, I’m going to lead a group of family medicine residents in a discussion of human trafficking cases; I will be working in the COVID-19 clinic that morning and that afternoon. I recognize that all of this sounds dangerously akin to self promotion, but the reality is that given my privileged position as a doctor and the scope of the problem, I feel that I’ve personally done very little towards combating either COVID-19 over the past 7 months or human trafficking over the past decade. That’s not my point. My point is that there is not a competition of awareness, focus, advocacy, or effort between the fights against these two assaults on our fellow Image-Bearers of God. The people who are fighting human trafficking are often the very same people fighting COVID-19.

And I humbly submit that memes which suggest otherwise may, in fact, be made by people who care about neither.


The Bad

I wanted to start with this one because I believe it’s somewhere in the middle in terms of both dismissiveness about COVID-19 and creating a false opposition between COVID-19 and Human Trafficking advocacy. The meme makes two claims; first a statistics claim about the relative risk of human trafficking and COVID-19, and the second a claim about the increased danger to children posed by masks because it perpetuates trafficking. Let’s look at both.

Though the numbers don’t usually matter much in posts like this one, I always like to know where they come from if possible. I went to the original source, an Instagram user who, apparently, works to promote “vaccine education, toxin free living, and government corruption.” I love it when people have eclectic interests.

At least she’s upfront about it.

Unfortunately, she doesn’t list where her numbers come from or how she ended up with this ratio of 66,667 children sold to human traffickers for every one child that dies of COVID-19, and I’m going to admit that it seems a bit high even to me, someone who leans towards more liberal estimates of human trafficking. The biggest problem with her numbers is that nobody actually knows how many children and adults are bought, sold, and enslaved through human trafficking each year; it’s an illegal, hidden, underground industry and the best we can do is estimate. It’s also very easy to misunderstand what the numbers actually mean; for instance, when experts say that an estimated 200,000-300,000 minors in the US are victimized through commercial sex trafficking each year, this is based on a much smaller number of actual reports, data from homeless youth and runaways, the personal narratives of adult sex workers who entered the life as children or adolescents, internet ads through websites like craigslist and backpage, and a variety of other data sources. Unfortunately, the vast majority of children who are being exploited in this way are not known. If we used this estimate (300,000) of US CSEC victims, divided by her 66,667, it would give us just 5 children in the US to die of COVID-19; since this is nowhere close, this clearly cannot be the figure she is referring to.

The experts I trust estimate that there are about 10 million child victims of human trafficking in the world today ( this number does not include the tens of millions of child brides across the globe, nor young or old adults who have been enslaved ever since they were children), and I think this must be the number of she is thinking of; nothing else even gets us close. Working backwards, this would give us an estimate of 150 children (10 million/66,667) who have died from COVID-19 worldwide. This is probably closer to the number of children in the US that have died from the virus; the best estimates that I can put together would put that number at around 100 (it’s tricky since the best data sources I can find don’t distinguish specific ages within the 15-24 yo age group; I don’t know how many from that age group were older adolescents and how many were actually young adults). We could look at this data from every possible angle (I typed a whole other paragraph on hypothetical calculations and assumptions we could make here, but deleted it; it doesn’t add to the discussion), but ultimately we are going to come out with an estimate that is certainly more than 150 but somewhere less than 1,000 child and adolescents deaths from COVID-19 infection worldwide.

So the best guess we can make is that the original author of this meme is comparing the total number of child slaves worldwide to some estimate she has found of the total number of child COVID-19 deaths that is, at least, on the right order of magnitude. There are at least five big problems with this “calculation” of a child being 66,667 times more likely to be sold to traffickers than to die of COVID-19.

First, the 10 million figure is an estimate of current child slaves, not new child trafficking victims; the idea of ‘being sold by traffickers’ paints the situations of enslaved people around the world as a monolith and ignores the debt bondage enslaving millions of families (which is still strongly associated with physical, psychological, and sexual abuse), which is by far the most common scenario for a child slave today. It also glosses over the many forms of control and exploitation included in human trafficking that don’t involve ‘being sold to a trafficker’, which we’ll talk more about in the next section. Sensationalist language hearkening back to ‘Taken’ is not at all helpful in understanding the scope of human trafficking and modern slavery.
Second, it’s very much an apples to oranges comparison since the 10 million estimate is a cumulative total built up over many years, and the number of children dying from COVID-19 is a total from just a few months of a pandemic; it is a comparison of prevalence to incidence, two very different epidemiological concepts. The total number of children trapped in slavery and the total number of children sold into slavery since February are clearly not synonymous, but the author of this meme has treated them as the same thing; this renders her figure, 66,667 to 1, utterly meaningless, since she isn’t even comparing the things she claims she is, let alone statistics that have a logical basis for comparison.
Third, this really is a straw-man. The discussion of whether or not to re-open schools is important, and the conversations I have every day with parents concerned about the risk of their children being harmed by COVID-19 are addressing very real anxiety. We talked about this with last week’s America’s Frontline Doctors video and will be trying to address it more fully in the coming week. But epidemiologists and physicians have at no point argued that COVID-19 was now the greatest threat to children worldwide; in fact we’ve come home from each and every shift incredibly thankful that this isn’t like the Spanish Flu pandemic of 1918, when children were disproportionately affected and killed by the virus. If it were, I’d probably be living in a tent behind our fence instead just changing on the patio and dodging my children on the way to a shower as soon as I come home. Nobody is saying that children dying from COVID-19 is the heart of the pandemic, and memes like this that want to put the number of child COVID-19 deaths ‘in perspective’ are ignoring the fact that child deaths have not been the main motivator for any of our mitigation efforts.
Fourth, and most importantly, the comparison doesn’t matter. Saying that one thing is terrible and dangerous and needs to be fought against doesn’t mean other problems aren’t important. Anyone can do this trick with any two terrible problems. You can say that human trafficking isn’t important because a child is 15 times more likely to be a victim of child abuse within the their own home, or that childhood cancer doesn’t matter because children are 6 times more likely to die from accidents. Just because two things are deadly doesn’t necessitate a comparison of their badness; we can be against both. The cynical side of me says that the only reason to use human trafficking, unless you are really trying to raise awareness about it, is because advocacy for victims of human trafficking confers an immediate moral high ground, and for some reason that is something that COVID-19 deniers feel they must have. They find human trafficking convenient because it paints them as compassionate and ethical and those fighting or concerned about COVID-19 as though they were ignoring this huge human trafficking problem. We wouldn’t expect them to set-up COVID-19 against something more morally benign that harms children, for instance swimming pools or hurricanes. I’d like you to stop and think about that for a moment; think about the fact that some people have decided that their personal crusade against COVID-19 justifies using human trafficking to score rhetorical points; that they have chosen to exploit the plight of human trafficking victims, some of the most exploited people in the history of the world, for their own ends.

But I’ve been wrong before.

Fifth, though it’s not as direct a correlation as with heart disease and immunocompromising conditions like cancer, there is a potential synergy between human trafficking and COVID-19, and it has nothing to do with masks. COVID-19 has, mercifully, killed relatively very few children, but it has left some children without one or both parents, and many more without one or more grandparents; adults who, when they are safe people themselves, confer the safety, security, and support networks that are protective against human trafficking. Despite our fears as parents (I am writing this sitting across from my 8 year old who is working on her math homework) (check that; supposed to be working on her math homework), most children who are victimized through human trafficking are not ‘taken’ from their front yards or from a big crowded event; they are preyed upon by traffickers who look for social vulnerabilities; want of support, care, and love; and circumstances where children and adolescents can be controlled. The logical conclusion of any of the memes or videos or posts that call us to lessen our focus on COVID-19 prevention, regardless of motive, is more deaths from COVID-19 among adults and elders- that is, parents and grandparents- and thus more children at risk for human trafficking in the years to come.

I also said that we would talk about the claim that having children wear masks makes them easier targets for human traffickers. Besides having, as far as I know, no verification for this claim, it also relies on sensationalized concepts of human trafficking and ‘oh that makes sense’ thinking; you are supposed to envision a child being walked along the street by human traffickers with family or friends passing within a few feet and not recognizing them because they are wearing a mask. This ignores the reality of trafficking victims’ experiences and the real methods of control used by traffickers; a problem it shares, though far less gratuitously, with the memes we will look at next.


The Ugly

As bad as it is to essentially make up statistics, and as bad as it is to artificially pit against each other two things that harm children as though you had to choose between them, and as though being vocally against one meant you were in support of or deaf to the other (“You are against a fake virus, while I am against human trafficking”), there is an even more exploitative type of meme going around the internet that takes these same goals and cranks the appeal to visceral emotion up to 11. After careful consideration I have decided not to share these images on my blog; I am sharing heavily redacted versions below, trusting you will recognize the type of macro I am talking about here.

“Let’s spend 4 paragraphs figuring out where that statistic came from” said no one ever

For those of you who have been mercifully spared from seeing the originals of these macros, or the many others circulating right now, they typically show one of three types of images in paired with text minimizing COVID-19 or juxtaposing it to human trafficking; a young child with tears in their eyes and a large hand over their mouth, a terrified child with a shadowy figure standing behind them, or a small girl bound with ropes, often in a basement or darkened room. For those who have seen and shared these images, I want to ask you to do something; go delete them (or change privacy settings; you can choose whether or not to delete them in a few paragraphs) before we move forward.

These images are deeply troubling and problematic for so many reasons that its actually hard to know where to start. “Minor” issues first, as we build towards the very worst and most troubling aspects of these images.

Bad statistics/misinformation:
Trying to get people to accept false numbers or misleading statistics by appealing to emotion rather than logic is a common propaganda tactic and we don’t need it in the fight against human trafficking. The problem is big enough on its own without hyperinflating the scope of it. We talked about the ‘66,667x more likely’ above, but the other number we commonly see is 800,000; 800,000 children are reported missing each year, and the implication is that they become victims of human trafficking. The reality is that most children being trafficked in sex slavery are not reported missing because they are being trafficked by family members or are in vulnerable situations where they would not be considered ‘missing’. Most child sex trafficking victims have not been kidnapped. Moreover, that 800,000 represents mostly missing children who were found very quickly; this is the number from a 2002 study for all children who were reported missing, and includes children who have runaway or gotten lost and family abductions during custody disputes; only 115 of these were what we think of as ‘kidnapping’. Missing children, family and non-family abductions, and all forms of child abuse are serious and important issues, and they all intersect with human trafficking and CSEC to some degree; but using statistics from one problem interchangeably with that of another, or using the most dramatic possible number you can find without careful explanation or honest reflection is not helpful.

Implying silence/neglect of human trafficking issues:
Comment accompanying the second image above reads “time to change the conversation.” This can be taken one of two ways; either ‘it’s time to start talking about human trafficking’, or ‘it’s time to stop talking about COVID-19′. I suggest the real goal of this meme is the latter, because unless you’ve been living under a rock for the past 10 years, we have been talking about human trafficking. To quote a friend who has a degree in modern slavery studies and has worked in this field, even if there are often problems with the organizations that only work to raise awareness of human trafficking without offering other support services or or contributing to the work in other more tangible ways, “they have at least done a good job at that.” Whenever I give lectures on human trafficking and modern day slavery, I always begin the same way; by asking for a show of hands of how many people have heard of this problem before and feel they know something about it. There has been a substantial difference in the response to that question over the past decade. One of the great things about volunteering in this field is that it is one of the few issues where people from all walks of life and ends of the political spectrum find a lot of common ground; we all agree that human trafficking is wrong. Some of us believe that pornography is a major contributing factor (more on that later), while others don’t. Some believe that legalizing prostitution is an important step in fighting it, while others don’t. Some believe that essentially all efforts to confront human trafficking should be secular while others believe that the Church has an important role to play. But despite these differences, there is more common ground to be had here than in the fight against almost any other societal ill. And that has made for fertile ground for grassroots awareness work; telling someone about human trafficking isn’t likely to start a debate or argument. 12 years ago we made shirts that said “slavery still exists” and “27 million slaves: ask me more.” Today the awareness focus has shifted to trying to help people understand modern slavery better and, often, combatting the sensationalist and misleading stereotypes that still persist. COVID-19 has not diminished the conversation around human trafficking, and images like these set it back rather than advancing it.

There is one extremely important point that needs to be made in this section, and I think here is the place to make it. Maybe you are new to human trafficking advocacy; maybe a meme like this is the first you’ve heard of it, and you naturally felt compelled to share. And if that’s the case I want to say two things. First, is that when we are talking about why these memes are problematic and my belief that some of them were made with bad intent, I by no means mean that I believe the people who have shared them have bad motives in doing so; I know for a fact that hasn’t been the case with the people who I’ve seen share the images above. I remember the sense of urgency I felt the first time I heard about children being used as soldiers by the LRA in Uganda; I rushed to my dorm and turned off the Halo game my roommates were playing to try to force them to watch the documentary (it didn’t go well) because I couldn’t believe no one was talking about this. If you are just learning about human trafficking and modern day slavery now, it probably feels the same, and the idea that some awareness efforts aren’t helpful because the images they show or the numbers they quote aren’t quite right must seem a bit strange or overly particular. My goal here is to help you understand why they are problematic, as someone who has been where you are but has since been learning about this for years, and to help you find better resources for raising awareness, like the ones I am sharing in this blog post. And the second thing I want to say is welcome, we are glad you are here; the fight against human trafficking needs you. And the first thing we need from you is to learn more, which is work that none of us can ever actually move on from. I recommend you start with Tuesday Justice’s Primer on Modern Slavery, and then read Kevin Bale’s Disposable People.

Racist overtones:
One of the recurrent visual themes we’ve seen throughout these social media images is the presence of both a child victim and an adult abuser, and the contrast between them. The child is small, the adult large. The child is terrified, the adult commanding and ominous. And often, the child is light skinned, the adult dark skinned. I don’t have exhaustive knowledge of the human trafficking memes that have been shared recently and can’t tell you what percentage of the time this is the dynamic presented. I also can’t tell you if this is done with lighting effects or if the photographer actually recruited white children and POC men for these photoshoots, or which of those options would make it worse; frankly the idea that children were asked to pose for these photos in the first place is troubling enough. But I don’t think these choices are accidental. The history of characterizing black men as hypersexual beasts and violent rapists in order to play into white majority fears of their children and young women being abused stretches back hundreds of years to the very beginning of our nation, and it has been a common theme in lynchings throughout American history. Malcolm Foley, Baylor University Special Advisor to the President for Equity and Campus Engagement and expert on the Church’s response to lynching in America, and my pastor, spoke about this briefly in his interview with Christianity Today following the death of Ahmaud Arbery. He in turn recommends you read Southern Horrors by Ida B. Wells, which addresses this topic in great detail.

“There is hardly a town in the South which has not an instance of the kind which is well known, and hence the assertion is reiterated that ‘nobody in the South believes the old thread bare lie that negro men rape white women.’ Hence there is a growing demand among Afro-Americans that the guilt or innocence of parties accused of rape be fully established. They know the men of the section of the country who refuse this are not so desirous of punishing rapists as they pretend. The utterances of the leading white men show that with them it is not the crime but the class. Bishop Fitzgerald has become an apologist for lynchers of the rapists of white women only. Governor Tillman, of South Carolina, in the month of June, standing under the tree in Barnwell, S.C., on which eight Afro-Americans were hung last year, declared that he would lead a mob to lynch a negro who raped a white woman. So say the pulpits, officials and newspapers of the South. But when the victim is a colored woman it is different.”

Ida B. Wells, Southern Horrors

If playing into sensationalism and parental fears has little to no place in the fight against human trafficking, there is even less justification for drawing on deeply rooted generational racism. By portraying abusers as men of color and victims as predominantly white children, these images are trying to recruit some of the ugliest and most harmful racist ideas buried in the heart of our society in order to fight human trafficking; but the fight against human trafficking doesn’t want or need those racist stereotypes. Moreover, these images are portraying a scenario that is not representative at all of the reality of race within human trafficking, a crime that disproportionately affects children of color, and reinforces stereotypes that themselves go hand-in-hand with racially motivated sexual abuse of trafficking victims. I hope you’ll read the article I’ve just linked from Love 146; it’s very short and shares the stories of three survivors whose race was a selling point their traffickers used to advertise them for sexual exploitation; please take a minute and read their words.

Misrepresenting human trafficking victims:
These images are also damaging and potentially dangerous because they so deeply misrepresent the real situations of victims of human trafficking. Though chains, ropes, cages and locked doors have been used to hold child and adult victims of human trafficking, they are not the most common methods. The techniques that traffickers use to control their victims are varied and sophisticated. Traffickers use shame, fear, and physical closeness in perverse combinations to make victims feel that they are the only person in the world that can be relied on or trusted. Many times they are family members or parents of the child being exploited, and use that relationship to maintain control. Other times they move victims to another city and strip them of their phones, ID’s, and social support networks to make the world outside the trafficker’s control feel even more dangerous and foreign. They use drug addiction, financial entrapment, and poor living conditions to create absolute dependence on the trafficker as a provider. They use psychological torture and manipulation to instill in their victims a sense that they are omniscient and omnipotent; they know everyone, they have contacts with the police, there is nowhere that the trafficking victim can run where they won’t find them. They use threats of violence credible and not; if you leave, I’ll kill your family, I’ll recruit your sister into the life in your place. They forge trauma bonds that make recidivism incredibly high and prosecution against traffickers extremely difficult. These methods, and many we haven’t touched on at all, make chains, ropes, cages, and locked doors unnecessary for controlling victims.

So why does it matter if these images paint a misleading picture of how victims of human trafficking are controlled and exploited? First, because it makes it more difficult for people to notice and report human trafficking when it occurs, something these memes claim to want to promote, if they are only ever looking for physical signs of restraint and enslavement. The work of grassroots advocacy and awareness organizations involves dispelling these myths so that people can really begin to understand the complex, nuanced, and insidious forms of control that are used, and learn to spot them in their interactions with victims of trafficking. When we train medical personnel to detect trafficking, we talk about the presence of a controller, sexualized language and patient narratives that normalize sexual abuse and violence, asking judgement free questions, and understanding the adverse medical findings associated with trafficking; looking for a cage or a rope is going to miss most cases of human trafficking, and all of the cases that could be detected in a medical setting. And second, because the misconception of trafficking control methods being limited to only physical forms of restraint like the ones in these images contributes to shame and victim blaming towards survivors. When we promote the idea that all trafficking victims and modern slaves are bound by ropes or chains, we are also stating the contrapositive; if you aren’t bound by ropes or chains, you aren’t really a trafficking victim. Adolescents are arrested for “prostitution,” a crime that can’t logically exist (children cannot consent to sex; “child prostitution” is always rape), and are frequently further victimized by law enforcement. They are rejected by families and loved ones because their serial victimization and the control methods they have suffered are seen as evidence of poor moral character. Society asks incredulously, “why didn’t you just leave?”, and we tell ourselves narratives that “I would have run away if it had happened to me,” without ever trying to understand what they had to endure. It even contributes to trafficking victims’ difficulty in recognizing their own abuse, because they may believe the cultural narratives that the incomprehensible torment they have endured as serial victims of rape and psychological torture don’t count unless they were handcuffed, caged, or tied-up at all times.

Sensationalizing the sexual abuse of children:
This is the hardest one to write about, and also the reason this post is now over 24 hours late. In my opinion it’s the biggest problem with the images above. Recently the Texas Medical Board began requiring that all licensed physicians complete training in human trafficking, and the Department of State Health Services (DSHS) released standards that those trainings should adhere to. Though the training we conduct had only one major revision because of this, we used it as an opportunity to update the entire presentation and ensure it was something that protected the dignity of human trafficking victims and survivors to the highest degree possible. The one revision; removing an image of two teenage girls standing on a street corner at night. And the reason we removed that image was because of this new training standard:

I mean, it’s the first one!

I’m including this training standard because I want you to understand that my objection to these memes and my request that you take them down if you’ve shared them, and kindly call them out when you see others sharing them, isn’t based on personal distaste or a negative visceral reaction (which is exactly the type of reaction they are meant to provoke). These are agreed upon standards and the idea of these images being harmful is accepted among those who fight against human trafficking every day; it’s just hard to articulate exactly why. We call these types of images sensationalized because we can’t quite call them sexualized; there is nothing sexual about a child experiencing fear and torment. Yet the image is meant to arouse disgust because we know that, to traffickers and johns and others who sexually assault children and adolescents, these are sexual images; in fact, I think you could rightly call them pornography. These images of children with adult hands covering their mouths, or bound and terrified with dark figures standing behind them, clearly send the message, “This child is about to be sexually assaulted.” I don’t know of anything that has less place in the fight against human trafficking than images that, if seen by one of the millions of men and women who have survived sexual assault or the ordeals of abuse through modern day slavery, would potentially traumatize them further and bring to mind those violations. These images are exploitive; they take the worst, most hopeless and fear-filled moments of the lives of real people and reproduce them for use as promotional materials. The fact that what the creators hope to promote is awareness is a mitigating factor, certainly; if these images were used for literally any other purpose we would chase the people creating these memes out of town, society, and history; we would call the FBI on them and put them on social media blast. But the ends do not justify the means, and we do not need simulated pornographic images depicting the moments before a rape or the psychological suffering of a child to convince people that this is an important issue. We need survivors’ stories. We need to understand the factors that contributed to their targeting, their control, and eventually to their empowerment and escape. We need to help young men and adult men understand that “non-consensual sex” is always rape and that desire for sexual interaction with the helpless and those who cannot consent is a serious mental health condition that needs immediate treatment, not a fetish or kink that can be safely indulged in as long as the victims are far enough away. We need to understand the complex networks of organized and non-organized elements that make up the human trafficking industry. We need to fight human trafficking by uniting across political and religious lines against the exploitation of children and the sexualization of innocence, not by dabbling in it as these memes do.


The Good

I think it’s important to note that not all memes that compare and contrast human trafficking to COVID-19 are necessarily problematic. The meme above is clearly different, while though it is using COVID-19 to grab your attention it is not trying to diminish the seriousness or reality of the pandemic. Further, it links to the Polaris Project, a reliable source of human trafficking information and resources, which also operates the National Human Trafficking Hotline, a free resource that anyone can call if they themselves need help or support or to report or ask advice about a potential human trafficking situation. Some of the verbiage, like “I wonder if … people would start paying attention?”, isn’t what I would choose and maybe falls under the idea of treating human trafficking like a neglected topic, which we talked about earlier… But this is very minor and may just be an issue of generational differences in meme tone and vocabulary.

This meme also shares data instead of sensationalized images and false statistics, and doesn’t try to play on fears, racist stereotypes, or false narratives about human trafficking. Finally, it comes from a source that is beyond question focused on helping women rather than minimizing COVID-19 concerns; the Montgomery County Women’s Center in Conroe, Texas, which provides sexual assault support services including legal support, crisis intervention, counseling, and advocacy. A quick search of their social media shows that they have indeed taken COVID-19 seriously and have modified their delivery of services and planned programming to keep their staff and clients safe from the virus; once again showing that any dichotomy between caring about COVID-19 and caring about victims of sexual violence is a false one.


How COVID-19 is like Human Trafficking and Modern Day Slavery

I know that by this point the title of this post, “Please keep comparing COVID-19 to Human Trafficking,” must feel like sarcasm or a particularly flimsy misdirect; but I promise you I really mean it. For me personally there are lots of similarities, not the least of which are the real harm and destruction I have seen them both bring to the lives of human beings created in the image of God, and the work I have accepted of helping provide accurate information to replace the misunderstandings about them that lead to deep seated fears. But there are a few other ways I think the comparison between these two pandemics is actually apt, if made responsibly:

There is lots of misinformation out there.
I would hope this post is proof enough that there is misinformation on both human trafficking and COVID-19 circulating widely. I said before that the role of grassroots awareness efforts on human trafficking has shifted from telling people that slavery still exists to helping people understand what modern day slavery is really like. This is invaluable work that is done best when informed and led by survivors or human trafficking, helping those of us in support sectors and the public in general understand the nuanced and complex nature of their experiences. Just like we try to do on this blog with COVID-19 videos and other medical misinformation, organizations like Unbound, Polaris Project, and Free the Slaves carefully break down the myths, popular stereotypes, and outright lies surrounding human trafficking and then tell the real stories of survivors and victims and the real story of human trafficking and modern day slavery. This aids in awareness, victim recognition, survivor support, laws that support survivors, and a culture that treats human trafficking victims as survivors instead of criminals. Without accurate, reliable data, this work is surrounded by a fog of biases and assumptions that inhibits the work of aiding survivors; we need to tell honest stories about human trafficking because when we share trafficking misinformation, it helps the traffickers instead.

You can make both problems worse without realizing it.
We’ve talked before about the danger of asymptomatic transmission of COVID-19, and studies which have shown (though the results are open to some interpretation) that the 48 hours prior to the onset of symptoms might actually be the most contagious period of time during an infection. As someone who has done pretty good but not perfect at social distancing throughout the pandemic, I find this especially concerning; all of us need to fight the false sense of security that comes with feeling healthy at the moment, thinking about our potential exposures and at-risk contacts even when we don’t think we are sick. That’s different from living in fear; living with a healthy respect for what this virus can do to us or our loved ones is wise, not fearful. But in addition to spreading this virus directly, we can make the pandemic worse with our other actions; sharing misinformation on the internet, failing to vet our sources when we share new or emerging information, supporting policies or politicians that minimize the very real danger of the virus, and fighting against non-nefarious common-well-being policies like wearing masks in public spaces. All of this increases the risks from the virus in much more subtle ways by creating a culture that minimizes personal responsibility and obfuscates the reasonable mitigation measures we can all take.

And almost the exact set of actions have a corollary in unwittingly supporting human trafficking. You probably contributed to human trafficking (as I did) today when you purchased products that had slave labor upstream in their supply chain. Some companies are better about monitoring their supply chain for slave labor than others, and there are groups that keep independent report cards for everything from the fashion industry to your local grocery store. But while buying blue jeans, chocolate, or a new smartphone may support labor trafficking and slavery in the supply chain throughout the world, there is one auxiliary consumer industry that supports sex trafficking specifically; pornography. These two industries are indelibly linked. A culture of widespread pornography use and addiction contributes to dehumanization of and violence towards women, and fetishizes demeaning sexual interactions, sexual violence, and rape, and it feeds the demand for sex trafficking from the consumer side. But the connection runs even deeper than that, because if you have consumed pornography you have not only supported the sex trafficking industry financially but have most likely participated in the sexual exploitation of trafficking victims as well. Many pornography websites, including the largest and most visited pornography website in the world (link is to an advocacy group video about the website, not the website itself, obviously), rely mostly or entirely on user uploaded content and do not have sufficient screening criteria in place to prevent the uploading and viewing of content showing the sexual abuse of children or adolescents, or content showing non-simulated rape and sexual torture. In fact, videos are often tagged with words like “teen”, “young girl,” or “innocent” in the title, yet are still streamed from their website without additional vetting or any requirement to prove that the women in the videos are actually consenting adults. This is not a theoretical risk; the sexual abuse of teenage girls and even children being streamed from these sites has been well documented. And once these videos are available on the internet, they can be next to impossible to have removed, as we have heard from survivors who have battled to have videos of their own rape taken down from these websites.

You can fight both right now.
As a physician, I’m here to tell you that you can fight COVID-19 right now in the comfort of your own home (by, you know, staying there). Wear a mask when you leave the house, physical distance while building up your social circle, reaching out to neighbors, loved ones, and friends remotely to see how they are doing 6 months into this pandemic and if there’s anything they need. Help fight against medical misinformation that contributes to unsafe, pro-COVID behaviors and attitudes. And you can fight human trafficking right now as well. Start reading with one of the resources above and keep reading and educating yourself about this important topic that isn’t going to go away even once COVID-19 is a distant memory. Look into the ways that your clothing, your food, and your other purchasing choices might help or hurt the plight of slaves around the world. If you’ve read this post and have decided it’s finally time to stop using pornography, go to a website like Fight the New Drug to get more information, support, and resources, and find an accountability partner to download an app like Ever Accountable and quit porn alongside you. Finally, consider donating to an organization like International Justice Mission that actively works to intervene in situations of slavery around the world, and then sticks around to provide the legal and support services to guarantee that survivors aren’t re-victimized by their traffickers.

So no, there isn’t a fight between awareness of human trafficking and focus on COVID-19, and the people who want you to believe there is may well care about neither one of them; but we are in the fight of our lives against both, and since you do care, we could sure use your help.