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.
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, alsodeserve 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.
We know this woman has Bell’s Palsy, or at least has visible symptoms consistent with that diagnosis.
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.
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.
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 beenand 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 halfthe 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 rightas 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.
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 mostto 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.
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 whatyou thinkthey 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 itor your doctor’simplies 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.
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 frightenedby 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 reprogramsyour 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.
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 waschanged 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 retaliatoryor 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.
There are a few salient facts you should know about this area of medicine.
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.
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.
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.
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.
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.
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 alsoso 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.
I have seen this video of Dr. Simone Gold, Dr. Stella Immanuel, and Dr. Dan Erickson, and other physicians in almost every format over the past 24 hours; from a 45 minute long version to just Dr. Immanuel’s comments. My favorite presentation of it, if I’m allowed to pick a favorite, is the headline that I saw first which read, “American Doctors Address COVID 19 Misinformation with SCOTUS Press Conference.” I know it’s the oldest tactic in the book, but something about people spreading misinformation by claiming they are fighting misinformation still really gets to me. I understand this video was viewed over 14 million times before youtube and social media sites began to take it down, and I understand why. The group, America’s Frontline Physicians, present themselves in patriotic themed lab coats (I did not know that was a thing) in front of the US Capitol (or whatever building that is; I was homeschooled), and tell Americans what we have all so desperately wanted to hear for months; there’s nothing to be worried about, your lives can go back to normal now.
Several of these physicians we are already familiar with. Dr. Dan Erickson’s interview with local news stations was perhaps the biggest COVID-19 misinformation viral video until Plandemic came along (a week later), and Dr. Simone Gold has gone viral multiple times; I addressed her “COVID-19 as a Mass Casualty Event” letter on the blog back in May. Though these doctors don’t know me from Adam, to me they are starting to feel like old friends; or at least old frenemies. They are becoming more sophisticated in the posturing they take around misinformation (that sounded ominous; “they are becoming more sophisticated”, like they were killer robots from SkyNet); including in their talk the idea that they are being ‘silenced’ even though tens of millions of Americans have heard their dissenting minority opinions, claiming to speak for ‘thousands of doctors’ (this is probably an accurate number; there are about 1.1 million doctors in the US), and painting a convincing picture of themselves as the front-line doctors ‘actually diagnosing and treating’ COVID-19 and the people ‘silencing’ (read: disagreeing with) them as shadowy powers-that-be, as opposed to just being the vast majority of conscientious front-line doctors who simply hold to higher standards of evidence and have less tolerance for the invasion of political concerns into our care of patients. All of this is lent some credence by the fact that this video is being censored on Youtube and Facebook, of course; but considering the views they share really are dangerous, I have to admit that I don’t know whether censoring the video is the right call or not; I’m glad it’s not my decision to make. My approach has been to analyse and discuss, and I’m thankful for those who have provided me with the transcript and alternative links to the video for me to try to do that.
Since I worked from 8-5 today, including a morning spent in our outdoor tent clinic diagnosing, treating, and counseling patients with COVID-19, and a motorcycle drive in a torrential downpour (it said 10% chance of precipitation!), I’m about 18 hours behind on responding to this video. In interest of making this analysis available to those who have asked for it more quickly, I’m going to take it one doctor at a time, starting with a response to Dr. Stella Immanuel’s comments. The full transcript is below, up to the Q&A which I won’t spend time addressing. My comments are in blue and will be added as I go.
TL;DR: Posting now, editing and adding to later. Reserve the right to wake up at 3 AM and fix spelling erros.
Congressman Norman: (00:00) … I’ll turn it over.
I have no idea who Congressman Norman is, but it has a very sinister ‘Spider-Man villian’ ring to it, doesn’t it?
Dr. Simone Gold
Dr. Simone Gold: (00:01) Thank you. Thank you so much congressmen. So we’re here because we feel as though the American people have not heard from all the expertise that’s out there all across our country. We do have some experts speaking, but there’s lots and lots of experts across the country. So some of us decided to get together. We’re America’s Frontline Doctors. We’re here only to help American patients and the American nation heal. We have a lot of information to share. Americans are riveted and captured by fear at the moment. We are not held down by the virus as much as we’re being held down by the spider web of fear. That spiderweb is all around us and it’s constricting us and it’s draining the lifeblood of the American people, American society, and American economy.
America’s Frontline Doctors seems like a new organization, but for COVID-19 Viral Video enthusiasts like myself, seeing them all together in this video feels like the first time we saw all of the The Avengers together in The Avengers after 4 years of build-up. The group’s logo is a caduceus overlaid with an American flag; a perfectly fine image, I suppose, but taken with their political aims it sends a clear message; “we are the only doctors that true American patriots can trust.” Later, when these physicians make claims that other doctors have not been using hydroxychloroquine, have been encouraging people to wear masks, or have been advising caution and social distancing because of political motivations, please remember exactly who has overtly politicized their medical calling and emblazoned it on their lab coats. You know what my lab coat has it on? Germs (that’s what they all have, which is why I don’t wear one).
I think Dr. Gold’s discussion of the fear capturing the American people here is very interesting. Certainly there are many responses to the deadly viral pandemic that America is facing; fear, anxiety, bravado, calloused indifference, defiance. I’ve had all of those responses myself, and that was just this morning. I have seen many people suffer from anxiety about the virus, for the sake of themselves and their loved ones, and have offered a listening ear and counseling (and, when appropriate, anxiety medication); I have also seen people who consider COVID-19 to be a political tool or a hoax and have shown brazen disregard of the very real danger posed by the virus, and a great many of them are going to watch and share this video. There is something fairly calloused and icky about sharing a message that ‘you don’t have to be afraid anymore’ to people you already know aren’t taking a dangerous thing seriously. Nevertheless, I’ve actually repeated Dr. Gold’s main point here, “I don’t want you to be afraid,” at least 100 times in the past week; probably far more. When I counsel patients who likely have COVID-19, or whose loved ones do, I almost always tell them that I don’t want them to be afraid. I also tell them about social distancing and counsel them on isolation precautions, and talk to them about getting in touch with their close contacts to encourage them to quarantine, and I talk with them about reasons they would return to my clinic or go to the ER or even call 911 if their symptoms worsen. Because my desire for them not to be afraid isn’t because there isn’t anything anything to be afraid of, like Dr. Gold claims, but because because fear leads to anger and anger leads to hate, and hate leads to suffering… Because fear is the mind killer, the little-death that brings total obliteration… Because with great power comes great (no wait that isn’t one, sorry)… But really because God has not given us a spirit of fear, and I believe that my patients will thrive best and be most free from fear when they have a healthy respect and understanding of the virus and how to protect others and respond to complications based on the best, most reliable information possible.
Dr.Simone Gold: (00:53) This does not make sense. COVID-19 is a virus that exists in essentially two phases. There’s the early phase disease, and there’s the late phase disease. In the early phase either before you get the virus or early, when you’ve gotten the virus, if you’ve gotten the virus, there’s treatment. That’s what we’re here to tell you. We’re going to talk about that this afternoon. You can find it on America’s Frontline Doctors, there’s many other sites that are streaming it live on Facebook. But we implore you to hear this because this message has been silenced. There are many thousands of physicians who have been silenced for telling the American people the good news about the situation, that we can manage the virus carefully and intelligently, but we cannot live with this spider web of fear that’s constricting our country.
Dr. Simone Gold: (01:45) So we’re going to hear now from various positions. Some are going to talk to you about what the lockdown has done to young, to older, to businesses, to the economy, and how we can get ourselves out of the cycle of fear. Dr. Hamilton.
Dr. Bob Hamilton
Dr. Bob Hamilton: (02:03) My name is Dr. Bob Hamilton. I’m a pediatrician from Santa Monica, California. I’ve been in private practice there for 36 years. And today I have good news for you. The good news is the children as a general rule are taking this virus very, very well. Few are getting infected. Those who are getting infected are being hospitalized in low numbers. And fortunately the mortality rate of children is about one fifth of 1%. So kids are tolerating the infection very frequently, but are actually asymptomatic.
And thank God for that. As a father of 4 young children, I cannot even imagine the anxiety, fear, and paranoia I would experience if we were living through a pandemic like the Spanish Flu, which disproportionately killed young children. I cannot imagine the pandemonium, the incredible amounts of fear, and even the difficulty in staffing clinics and hospitals if exposure to the virus put our children‘s lives at great risk instead of just our own. Though Dr. Stella Immanuel below discusses the panic that her patients commonly present with when they believe they may have COVID-19, I’ve only see this a few times; many patients need reassurance and education, but only a handful have been truly on the verge of a panic attack. But I have seen many, many people very concerned about their children and grandchildren. In fact, when I inform patients that they have been diagnosed with COVID-19, they usually ask “what about my children?” before they ask any other question.
The truth is we don’t know the mortality rate among children, for a lot of the same reasons that it’s so hard to lock-down a true infection fatality rate in general; imperfect testing, asymptomatic cases, minimally symptomatic cases that are never tested, and still being fairly early in the course of the pandemic and not having all of the data we need. But we all agree it’s smaller than for older patients, and Dr. Hamilton’s estimate of 0.2% is within the commonly accepted range based on the data we do have. I would point out that 0.2% is still a very alarming mortality rate for a virus that is as infectious as COVID-19; but a lot of us hope the rate is actually even lower and that children tend to be asymptomatic or minimally symptomatic at a high enough rate that we are simply missing most cases. We hope, but we don’t know. So while I can counsel the patients who anxiously ask me if their children are going to be ok (which would be the very first question on my mind as well) that they are at less risk from COVID-19 than any other age group, I cannot promise them that their children will be unaffected or free from risk, and I still counsel them on what to watch for.
Dr. Bob Hamilton: (02:38) I also want to say that children are not the drivers of this pandemic. People were worried about, initially, if children were going to actually be the ones to push the infection along. The very opposite is happening. Kids are tolerating it very well, they’re not passing it on to their parents, they’re not passing it onto their teachers. Dr. Mark Woolhouse from Scotland, who is a pediatric infectious disease specialist and epidemiologist said the following. He said, “There has not been one documented case of COVID being transferred from a student to a teacher in the world.” In the world.
I think here Dr. Hamilton is straying into a fairly disingenuous way of looking at these statistics. One of the first and most widely followed mitigation steps early in the pandemic was to transition schools to online learning. More than closing non-essential businesses, more than observing social distancing, more than wearing masks once sufficient evidence to support mask-wearing was amassed, children were compliant with not being in school at very high rates because schools were, physically, closed. I will accept that children have not been thedriver of the pandemic; they are also one of the groups that has been kept at home most successfully during it. Saying children have not driven the pandemic is not the same as saying they would not have or might not if these mitigation measures were not followed. The question of whether or not children can or will drive the pandemic once schools reopen in person is nuanced and difficult; I’ll try to address it in the next paragraph and in greater detail in a later article. But it’s important that we don’t fall into the trap of evaluating the course the pandemic has taken so far without taking into account the effects of the precautions and mitigation measures we havetaken in response to it.
Dr. Bob Hamilton: (03:19) I think that is important that all of us who are here today realize that our kids are not really the ones who are driving the infection. It is being driven by older individuals. And yes, we can send the kids back to school I think without fear. And this is the big issue right now, as Congressman Norman alluded to, this is the really important thing we need to do. We need to normalize the lives of our children. How do we do that? We do that by getting them back in the classroom. And the good news is they’re not driving this infection at all. Yes, we can use security measures. Yes, we can be careful. I’m all for that. We all are. But I think the important thing is we need to not act out of fear. We need to act out of science. We need to do it. We need to get it done.
Again, just because children in school have not driven transmission so far, because they have not been in school, doesn’t mean that it isn’t a risk. I don’t know whether or not we should reopen schools normally in a few weeks. There are lots of reasons I haven’t been able to come to anything like a firm conclusion about it. The data is complicated, and it’s such an important question that it really does require a degree of thorough research and critical thinking that I have not been able to give to it yet. Part of that is my own privilege; my wife and I homeschool our four children (and I include “and I” very generously), so it’s a question that doesn’t personally affect us. Homeschooling has always involved some degree of privilege, even though it is also challenging and requires sacrifice, but that’s never been quite so obvious to me as it is now in the midst of this pandemic, when this one big question mark seems to be looming over nearly every family we know but our own. But even though it doesn’t directly affect our own children, there are many teachers and school aged children that we deeply care about (and tons that we sort of care about or middling care about), and the question has been heavy on my mind, especially as more and more close friends have asked me to research and write about it.
All of that to say, I don’t have an answer today; I hope to write about it soon, but I can’t promise I’ll have an answer then either. For now I’ll say this; I think the burden of proof has to be on the side of proving it’s safe, not on the side of proving it’s not safe. I need to review the studies on transmission and shedding in children, but the claim I’ve seen that children are very unlikely to transmit the virus seems very counter-intuitive. Transmitting respiratory viruses is what children do. I’ve got four of these booger goblins at home; the little one gives kisses by putting his entire mouth around your nose, and the 2nd youngest “whispers” to you by blowing spit into your ear and your eyeball. One of the questions we always ask someone with a cold or flu, even pre-COVID-19, is whether they have been around anyone sick. If the answer is “well I have kids” or “well I work in a school” my response is, “say no more.” If there’s one thing we’ve learned about COVID-19, it’s that it’s different. Maybe kids really don’t shed it, maybe they really don’t spread it to each other or to adults; maybe we can reopen schools with sufficient distancing guidelines that it will not endanger the lives of children or or adolescents or their caregivers, teachers, or families. If that’s the case, that’s wonderful; but it has to be very, very clearly demonstrated by real scientific evidence. It isn’t something we can risk on the type or quality of “evidence” that some of the members of America’s Frontline Doctors seem to find sufficient. We’ll try to look at as much of that evidence as we can in an upcoming post.
Dr. Bob Hamilton: (04:07) Finally, the barrier, and I hate to say this, but the barrier to getting our kids back in school is not going to be the science, it’s going to be the national unions, the teachers union, the National Education Association, other groups who are going to demand money. And listen, I think that it’s fine to give people money for PPE and different things in the classroom. But some of their demands are really ridiculous. They’re talking about, where I’m from in California, the UTLA, which is United Teachers Union of Los Angeles, is demanding that we defund the police. What does that have to do with education? They’re demanding that they stop or they shut all private charter schools, privately funded charter schools. These are the schools that are actually getting the kids educated.
This gets too deep into politics for me. Look at the various teachers unions’ demands (if they have demands) in your area for yourself and see if you think what they are asking for is reasonable. Better still, talk to teachers you know and ask for their opinion on reopening schools, the same way that you would (hopefully) ask me or another physician you know about our views on wearing masks or other medical issues related to the pandemic. I know some teachers, and I know that their greatest desire (besides something called a “smart board”) is to be back in the classroom educating and pouring life into your children. They want the schools to reopen, but they want to know the safest and wisest way for it to happen, because too much of their job already deals with childhood suffering, and seeing anything like an abnormally high number of their students (your children) die from COVID-19 because we re-opened schools in the midst of a surge of cases would break them. No profession is perfect (something I’m hoping to write about soon too, but in the meantime you should go read Harriet Washington’s Medical Apartheid for yourself), but if you don’t think doctors in general want you to be well and thrive, and you don’t think teachers want your children to grown and learn, I’ve got some questions about who you do trust.
Dr. Bob Hamilton: (04:59) So clearly there are going to be barriers. The barriers will not be science. There will not be barriers for the sake of the children. That’s going to be for the sake of the adults, the teachers, and everybody else, and for the union. So that’s where we need to focus our efforts and fight back. So thank you all for being here and let’s get our kids back in school.
Leave out that there really are some scientific barriers to knowing whether or not fully reopening schools is actually going to be safe for the children, which is probably the single biggest concern among teachers anyway; there’s still something very calloused about calling out teachers for not wanting to re-open schools because of concerns about their own safety.
Dr. Stella Immanuel
Dr. Stella Immanuel: (05:27) Hello, I’m Dr. Stella Immanuel. I’m a primary care physician in Houston, Texas. I actually went to medical school in West Africa, Nigeria, where I took care of malaria patients, treated them with hydroxychloroquine and stuff like that. So I’m actually used to these medications.
I’ve learned an awful lot from African physicians over the years, though I’ve never been to Nigeria and have not had the privilege to travel to West Africa since before medical school. I do not know the arc of Dr. Immanuel’s career, how long she practiced in Nigeria and how long she has now practiced in the US (I am told she used to live in the same city where I did undergrad). On my most recent short term trips to volunteer in hospitals in South Sudan and Uganda, I went in a teaching role; and while I did have some things to contribute, there is no question that I gained from doctors there more knowledge and insight than I was able to give, which is what I fully expected would happen. And nowhere was this dynamic more clear than in treating patients with “tropical diseases” like yellow fever and malaria. Diagnostic tests, medications, and clinical pictures that I had encountered primarily in textbooks were bread and butter medicine for the physicians I worked with, and I’m sure I must have seemed fairly slow on the uptake, trying to figure out the right chloroquine dose for pediatric malaria patients or recognize the differences in the clinical picture between malaria and dengue fever. While I’ve now also used these medications for malaria, in addition to prescribing them for lupus here in the US, I would completely concede more extensive experience with antimalarial agents to a West African trained doctor like Dr. Immanuel. What I cannot honestly concede is more extensive experience diagnosing and treating COVID-19.
Dr. Stella Immanuel: I’m here because I have personally treated over 350 patients with COVID. Patients that have diabetes, patients that have high blood pressure, patients that have asthma, old people … I think my oldest patient is 92 … 87 year olds. And the result has been the same. I put them on hydroxychloroquine, I put them on zinc, I put them on Zithromax, and they’re all well.
The best way to study a medication’s efficacy is a double-blinded, randomized, controlled trial. There are studies that have been done and are being done on hydroxychloroquine for COVID-19 that are designed this way, and if done carefully they will provide the absolute highest quality data we will have on this medication. So far the ones we have do not show benefit. It’s worth pointing out here that one large, well-designed study is of much greater value than many small or poorly designed studies, and of infinitely greater value than any one or a few clinicians’ anecdotal experiences. But in a pandemic I do believe in an all-hands-on-deck approach to both clinical treatment and research, and I appreciate all of the doctors for whom research is not a usual interest or activity taking the time and energy to bring their results forward.
But we would not be wise to digest these results without understanding their significance. When Dr. Immanuel says she has treated 350 patients for COVID-19, that feels like a fairly large number; especially compared to the dozen that Dr. Bartlett had treated to support his claims for budesonide or the 50 that Dr. Procter had treated in a recent viral facebook post. But we still need more information, like how her patient population’s demographics compare to the population in general, which she only hints at, telling us the age of her oldest patient but not providing a median age or other demographics factors or data on comorbidities or high-risk conditions. Depending on their risk factors and their ages, zero deaths out of 350 might be exactly what we would expect. Even if Dr. Immanuel’s population perfectly represented thegeneralpopulation (and we have good reasons to suspect this is not the case, as we will discuss below), where we believe the infection fatality rate is somewhere in the still-very dangerous- range of 0.4% to 1.3%, this would only be 1-4 fewer deaths than expected; wonderful, well worth celebrating, but not miraculous, and certainly not proof of a cure. But aside from the simple numbers, there are bigger issues we need to be honest about here.
Dr. Stella Immanuel: (06:12) For the past few months, after taking care of over 350 patients, we’ve not lost one. Not a diabetic, not a somebody with high blood pressure, not somebody who asthma, not an old person. We’ve not lost one patient.
As I’ve done for every doctor making claims of perfect efficacy for unproven medications over the past few months, I’d like to look at Dr. Immanuel’s claims in the context of her treatment setting; namely, outpatient Family Medicine in Houston, Texas. Here is the graph of positive cases in Houston.
If this looks familiar to my fellow Wacoans, maybe it’s because it looks almost identical to the trend in cases in Waco, and really in most places around Texas. Here is our trend from April to July from the health department’s tracker at covidwaco.com (based on positive test results).
You’ll note these charts are not to the same scale; Waco does not (yet) have a population of 2.3 million people. But there are only so many patients a doctor can see in a day, and both Waco and Houston have had plenty of COVID-19 cases, and people being evaluated for possible cases, to keep more than one doctor very busy, and it’s pretty hard for me to imagine that Dr. Immanuel has seen many more patients for evaluation of COVID-19 symptoms than I have over the past couple of months. But if we look at these trends it strongly implies that the vast majority of her patients who actually had COVID-19 would have been in the past 6 weeks, just like mine have been; before that the infection rates in Houston and in Waco were too low for either of us to have extensive experience with patients who actually had the virus, regardless of how many people we were evaluating and testing (important work still, since none of us knew when our surge would start). She doesn’t tell us how many of her 350+ patients were in March, April, and May and how many have been since mid-June, just that she has treated that many patients with hydroxychloroquine over the past several months. If we assume that the majority of these patients have been in the last 42 (great number) days since cases began to climb in Houston, it means that a lot of her patients are not out of the woods yet. There is a lag time from the development of early symptoms of COVID-19 to the development of severe complications, and a further lag time from this to death, while patients fight for their lives in the hospital and doctors and nurses do everything in their power to help them. Finding an exact number is difficult because there are so many factors and so many different ways that people are affected by the virus; but the total lag from onset of symptoms to death seems to be around 18 days. Even this is likely an underestimate, however, since any such data would exclude people experiencing a prolonged battle with the virus who are still fighting it at the time the data is collected, but ultimately pass away from it later. This gives us a mere 24 days during which we can say Dr. Immanuel has had time to see a significant number of patients with COVID-19 and feel confident in saying that those patients have fully recovered and are no longer in danger.
I am playing a bit fast and loose with these numbers here, because I don’t actually think Dr. Immanuel means that the majority of her 350 “COVID patients” have been within the past 6 weeks. The point is this; when doctors claim to have been treating COVID-19 a certain way for months, you need to look and see how many months there have actually been COVID patients in their area. Because if the length of time they have been ‘treating COVID’ successfully and the length of time that SARS-CoV-2 has been endemic in their region don’t line up, we have to ask an important question that runs deeper even than the demographics and risk factors of their patients; did the patients they treated even have COVID-19 at all?
You see, over and over when we have heard from physicians like Dr. Irene Lozano and Dr. Brian Procter that they have a 100% cure rate with hydroxychloroquine or another regimen, it turns out that their definition of ‘having COVID-19’ is extremely liberal. One admits to treating patients with minimal symptoms and questionable exposures; the other says he doesn’t even believe in testing for COVID-19. This is the most basic concept of epidemiology imaginable, but you can’t die from a disease you don’t have. If a doctor says they have successfully treated a condition x number of times, but their diagnosis of the condition doesn’t conform to accepted standards of certainty or rely on any evidence other than a hunch or their desire or ideological commitment to ‘diagnose’ and treat the condition, their results are less than useless; they don’t even count as anecdotal evidence.
I don’t know if this is the case for Dr. Immanuel; she doesn’t say that she doesn’t believe in testing, she doesn’t tell us what test her clinic uses or its sensitivity and specificity, or how many of her hydroxychloroquine patients were treated during Houston’s pre-surge months, or if she uses the accepted clinical diagnostic criteria in lieu of a positive test. I cannot say definitively that Dr. Immanuel has done what so many doctors in these videos have done and artificially inflated her COVID-19 patient series by treating people who did not meet any accepted diagnostic criteria but were merely worried they might have the virus. But this is absolutely key to understanding the significance of her success rates, and I do think she gives us a few important clues in that direction.
Dr. Stella Immanuel: And on top of that, I’ve put myself, my staff, and many doctors that I know on hydroxychloroquine for prevention, because by the very mechanism of action, it works early and as a prophylaxis. We see patients, 10 to 15 COVID patients, everyday. We give them breathing treatments. We only wear surgical mask. None of us has gotten sick. It works.
This is clue number one, and it’s a big one. I sometimes use a phrase I’m pretty sure I’ve coined; “we aren’t keeping the secret medicines for doctorshidden in the back.” I say this, when I think it’s appropriate to the patient, to help dispel the idea that I am holding out some sort of secret treatment that I only prescribe to other doctors and their families, which is something that my patients sometimes believe (and that some of them have very good historical reasons for believing). A compassionate, conscientious physician is going to treat your condition the same whether you have an MD or PhD or have very little education, whether you are rich or poor, and even whether or not they like you or you are mean to them; we don’t keep secret medicines in the back that you don’t unless you are ‘in the club.’ And because I believe that Dr. Immanuel is a compassionate physician, I don’t believe that she would be willing to give herself, her staff, and other doctors and medical personnel hydroxychloroquine as prophylaxis if she were unwilling to do the same for others. If she really believes it works in this clinical setting, it would be consistent of her to offer hydroxychloroquine for patients who have been around others with COVID-19, or thought they might have been, or who work in other high risk environments like nursing homes, food service, and grocery stores. And because she has more extensive experience with hydroxychloroquine for malaria treatment and prophylaxis than most US trained physicians, it would be reasonable to expect her to be somewhat more liberal in prescribing it for this purpose without the same degree of anxiety a doctor might feel who has only used it for lupus.
In claiming that she has successfully treated over 350 patients with COVID-19 with hydroxychloroquine, is Dr. Immanuel including the patients she has treated merely for prophylaxis, who have not been diagnosed with an infection at all? I don’t know, but considering the national stage and the passion she feels on this issue, I would feel a great degree of temptation to include those patients and bolster my treatment numbers, and if I wasn’t including them I would want to be explicit on that point.
Dr. Stella Immanuel: (06:46) So right now, I came here to Washington DC to say, America, nobody needs to die. The study that made me start using hydroxychloroquine was a study that they did under the NIH in 2005 that say it works. Recently, I was doing some research about a patient that had hiccups and I found out that they even did a recent study in the NIH, which is our National Institute … that is the National … NIH, what? National Institute of Health. They actually had a study and go look it up. Type hiccups and COVID, you will see it. They treated a patient that had hiccups with hydroxychloroquine and it proved that hiccups is a symptom of COVID. So if the NIH knows that treating the patient would hydroxychloroquine proves that hiccup is a symptom of COVID, then they definitely know the hydroxychloroquine works.
Dr. Immanuel is referring to a case report from April of one patient, a 62 year old man who presented to the ER with hiccups; he was found to have diffuse groundglass opacities on CT scan of his lungs and tested positive for COVID-19. The case study mentions that he was treated with hydroxychloroquine exactly once (twice if you count the abstract); it was standard treatment at the time this man was admitted, as it was in most places around the country before more evidence emergedthat it wasn’t efficacious. The study draws absolutely no conclusions that his COVID-19 was cured by hydroxychloroquine, but rather was published to emphasize that “physicians should keep COVID-19 infection on their differential as more cases are discovered through atypical presentations.” The idea that this case study somehow proves that the NIH “knows the hydroxychloroquine works” is a complete non-sequitur and betrays either intentional or accidental misunderstanding of the case study. Also, I love it when people google things and then post viral videos telling other people to google those things; it creates fascinating Google Trends graphs:
Dr. Stella Immanuel: (07:42) I’m upset. Why I’m upset is that I see people that cannot breathe. I see parents walk in, I see diabetic sit in my office knowing that this is a death sentence and they can’t breathe. And I hug them and I tell them, “It’s going to be okay. You’re going to live.” And we treat them and they leave. None has died.
This is clue number two. You see, Dr. Immanuel has fallen into the trap that so many other doctors whose claims we have looked at on this site have fallen into; they are actually treating the virus as though it were even more dangerous than it already is. Most doctors I know would accept a death rate for COVID-19 somewhere between 0.4 and 1.3% based on the best data we currently have available; incredibly dangerous, but not a death sentence. The diabetic patient with COVID-19 is most likely to recover without treatment, but if unchecked the virus could easily kills hundreds of thousands or even millions. That’s what happens in most dangerous, contagious illnesses; if unmitigated, it will kill far too many people, but any particular person is still statistically unlikely to die. In fact, I spend a lot of my time saying to my patients I am testing for COVID-19 almost what Dr. Immanuel is saying. I don’t hug them, but I do offer a therapeutic hand on the arm and say, “I think you’re going to be ok. Most people recover from this and never have to be in the hospital. Let’s talk about what to watch out for and how you can feel a little better while your body fights this.” By believing that this virus is almost universally deadly for certain people, she is ensuring that her evaluation of her treatment numbers is biased, because she then cannot objectively compare her survival rates to the real death rates. Each case proves the drug was the key, miraculous cure, because she’s convinced that each patient she treats would have died without it.
Dr. Stella Immanuel: So if some fake science, some person sponsored by all these fake pharma companies comes out say, “We’ve done studies and they found out that it doesn’t work.” I can tell you categorically it’s fixed science. I want to know who is sponsoring that study. I want to know who is behind it because there is no way I can treat 350 patients and counting and nobody is dead and they all did better.
Two things on this. Most of the COVID-19 and hydroxychloroquine studies that have come out have not been sponsored by any pharmaceutical company (I can’t think of any that have off the top of my head), and this is the first time I’ve ever seen someone accuse drug companies of fixing data to prove that there was no specific drug therapy available. (yes, yes, I know; they are just setting us all up for a vaccine).
But more importantly, there absolutely is a way that she could treat 350 patientswith no deaths and it not be due to hydroxychloroquine, because many doctors around the country have exactly these same types of numbers withoutusing it. In fact, this is almost exactly what my numbers look like. I don’t feel at liberty to disclose the numbers or any details from my clinic without authorization from those patients; but I have been treating at least 20-30 patients for COVID-19 symptoms and exposure daily for weeks, and evaluating a significant number for the symptoms of COVID-19 in the months leading up to the beginning of our surge 6-7 weeks ago. I have treated well over 350 patients for suspected COVID-19, and many have been positive for the virus. None of them have died, praise God.Would I be justified in attributing this to something I am doing? Is it my particular form of counseling and reassurance? Is one of the symptomatic/supportive treatments I am recommending, like tylenol for body aches or hot tea with honey for sore throat, secretly an anti-COVID-19 miracle drug? Does mybreath inhibit COVID-19? Of course not. The difference is that none of these have a theoretical mechanism of action against COVID-19 (although my breath may encourage social distancing), and many medications like hydroxychloroquine and budesonide do. I am extremely hopeful that studies will prove some clinical setting or scenario where these really are useful for COVID-19; but using before then because of unreliable anecdotal evidence is irresponsible.
We would be better served looking at my patients, if we could. Some were only recently diagnosed and, as we’ve already stated, aren’t out of the woods yet. If you don’t think I’m deeply concerned about some of these patients getting sick in the next week or two, you haven’t been reading my blog. Many were exposed but did not develop the virus. Many had only a mild clinical course and few risk factors, including age. Many had symptoms that meant they would screen positive for further evaluation for COVID-19, but were actually ultimately due to something else; a bacterial pneumonia, a COVID-19 unrelated COPD exacerbation, migraine headaches, pregnancy. Do I get to count all of them in my ‘COVID-19 treatment’ numbers since I saw them for suspected COVID-19 based on their presenting symptoms? More importantly, these patients self-selected to my clinic by not being ill enough to need to call 911 or present straight to the ER, or by not being elderly enough or having enough medical complications to already live in certain very high-risk settings, like a long term skilled nursing facility, where they would be evaluated by another doctor entirely. If I had placed all of these hundreds of patients on hydroxychloroquine, zinc, and azithromycin, (and if none had adverse events or serious reactions to these medications), their outcomes would have been exactly the same. The only difference would be that they would have purchased and taken unnecessary medications and I would be convinced that I have locked-on to the miracle cure. After that, if any of my patients did die from COVID-19, I would probably be convinced I was still beating the odds.
Dr. Stella Immanuel: (08:21) I know you’re going to tell me that you treated 20 people, 40 people, and it didn’t work. I’m a true testimony. So I came here to Washington DC to tell America nobody needs to get sick. This virus has a cure. It is called hydroxychloroquine, zinc, and Zithromax. I know you people want to talk about a mask. Hello? You don’t need mask. There is a cure. I know they don’t want to open schools. No, you don’t need people to be locked down. There is prevention and there is a cure.
Do not trust anybody with your medical care who tells you don’t need prevention because you can just do treatment. Please wear a mask.
Dr. Stella Immanuel: (08:48) And let me tell you something, all you fake doctors out there that tell me, “Yeah. I want a double blinded study.” I just tell you, quit sounding like a computer, double blinded, double blinded. I don’t know whether your chips are malfunctioning, but I’m a real doctor. I have radiologists, we have plastic surgeons, we have neurosurgeons, like Sanjay Gupta saying, “Yeah, it doesn’t work and it causes heart disease.”
I’m a real doctor too and I believe in evidence based medicine. Also, take that all of you radiologists, would-be-plastic-surgeons, and neurosurgeons who did better than me on your boards (you know who you are. Miss you guys); I’m a real doctor!
Dr. Stella Immanuel: Let me ask you Dr. Sanjay Gupta. Hear me. Have you ever seen a COVID patient? Have you ever treated anybody with hydroxychloroquine and they died from heart disease? When you do, come and talk to me because I sit down in my clinic every day and I see these patients walk in everyday scared to death. I see people driving two, three hours to my clinic because some ER doctor is scared of the Texas board or they’re scared of something, and they will not prescribe medication to these people.
This is clue number three. Just like Dr. Lozano and Dr. Procter, Dr. Immanuel has patients driving across the state to see her because they know she will prescribe these hot-button medications for them even when other doctors wouldn’t. If you don’t understand why this is problematic or how this distorts her treatment numbers, please see my prior posts on those doctors’ claims.
Dr. Stella Immanuel: (09:35) I tell all of you doctors that are sitting down and watching Americans die. You’re like the good Nazi … the good one, the good Germans that watched Jews get killed and you did not speak up. If they come after me, they threaten me. They’ve threatened to … I mean, I’ve gotten all kinds of threats. Or they’re going to report me to the bots. I say, you know what? I don’t care. I’m not going to let Americans die. And if this is the hill where I get nailed on, I will get nailed on it. I don’t care. You can report me to the bots, you can kill me, you can do whatever, but I’m not going to let Americans die.
I’m choosing to leave this one alone for the most part. Dr. Immanuel has been widely lambasted on social media for holding a number of medical and non-medical beliefs far outside of the norm, some of which are heterodox religious ideas, some of which are conspiracy theories, and some of which are just plain strange. I think her comparison of doctors like myself to Nazi scientists and doctors because we aren’t willing to use unproven medicines and some of the other references in this paragraph hint at that. While I do think that this line of conversation sadly does have some value- it is important to understand if the people we choose to give credence to are reliable sources of truth- I feel that my calling here is to speak to Dr. Immanuel’s arguments, statistics, and scientific interpretations alone.
Dr. Stella Immanuel: (10:09) And today I’m here to say it, that America, there is a cure for COVID. All this foolishness does not need to happen. There is a cure for COVID. There is a cure for COVID is called hydroxychloroquine. It’s called zinc. It’s called Zithromax. And it is time for the grassroots to wake up and say, “No, we’re not going to take this any longer. We’re not going to die.” Because let me tell you something, when somebody is dead, they are dead. They’re not coming back tomorrow to have an argument. They are not come back tomorrow to discuss the double blinded study and the data. All of you doctors that are waiting for data, if six months down the line you actually found out that this data shows that this medication works, how about your patients that have died? You want a double blinded study where people are dying? It’s unethical. So guys, we don’t need to die. There is a cure for COVID.
This is painful, because she’s absolutely right; dead is dead (although some of us believe that’s not true at all). And if in 6 months I have lost COVID-19 patients and a large, well-controlled, double-blinded placebo controlled study does overturn all the best evidence we have so far and proves that hydroxychloroquine would have saved those patients if I had just given it to everybody who thought they might have the virus or who had certain risk factors or a certain constellation of symptoms, I will be sad that I didn’t use it. I’ll write about it on this blog, and my agony over it will probably come through pretty clearly because I’m not great at hiding that kind of thing. But what I won’t be able to say is “it turns out Dr. Immanuel was right” or “it turns out Dr. Procter was right.” Because recommending a medication that later turns out to be useful based on bad data, misunderstanding statistics, shifting the goalposts of what it means to diagnosis an infection or what constitutes valid evidence, and indiscriminate prescribing designed to bolster my own confirmation bias is still wrong. What’s that saying, something about a blind squirrel is still right twice a day, and we shouldn’t… be blind squirrels… leading the blind? Being right for the wrong reasons is called being lucky (or in the absolute best case scenario, deeply intuitive), and it’s great for you and your patients; it isn’t something anyone can reasonably or ethically follow you in.
How many medications do you take? There are over 20,000 prescription drugs approved by the FDA; unless you take that many, there are probably some out there that might help a symptom or a condition you have; maybe even some that might save your life. We could put you on chemotherapy because you might have cancer. We could put you on daily antibiotics because it might prevent your next urinary tract infection. More to the point, we could treat you with chronic opioids because they have a mechanism for helping your pain, even if your pain is unlikely to have any long-term improvement from them and you run the risk of opioid dependence, a condition I treat every day and have seen ruin lives in ways you wouldn’t believe. We could treat every child who might have an ear infection with antibiotics, regardless of diagnostic standards and the very real risks of antibiotic resistant bacteria (not to mention diarrhea diapers). We could put every flu patient on tamiflu even though it can be a harsh medication and has only limited efficacy in limited clinical scenarios.
No Dr. Immanuel, it is notunethical to refrain from using a medication in a clinical scenario where it has no proven efficacy. This is the philosophy that led to the opioid epidemic and every day leads to polypharmacy, another very real killer of the elderly. We took oaths to first do no harm, and sometimes that means sitting in the tension and anxiety of an unknown future with our patients and admitting, regardless of our own hubris, that we don’t have anything special or prescribable to offer other than our sound advice, sincere compassion, and reliable information. In fact, this is actually a pretty big part of our jobs already.
If 6 months from now (or hopefully sooner) some reliable evidence shows that hydroxychloroquine has a use in specific scenario to treat COVID-19, I will be the first one to prescribe it. Until then, the anecdotal evidence isn’t strong enough, the mechanism of action not surefire enough, and the scientific evidence not promising enough to justify the type of widespread everyone-gets-a-dose treatment these doctors are espousing; and unfortunately, despite her passion and her compassion for her patients, Dr. Immanuel’s clinical evidence, at least as she has shared it here, adds to that data not even at all.
From this point the press conference continued for another half hour. America’s Frontline Doctors is prolific; since this video they have also released additional hour and even three hour long videos. Although I think there are many points from the remainder of the video that could be analyzed, including quite a few I agree with, some that need clarification or explanation, and some that deserve to be debunked, I have to accept my limitations and accept that at this point analyzing the remaining claims is not the most pressing use of my time.
My apologies to anyone who might have been waiting for me to address a specific point in the remainder of the press conference; please do not hesitate toget in contactwith me with specific questions, which I may be able to integrate into future posts.
I have deleted the remainder of the transcript since I do not have plans to address the remaining points, but it can be found here and the video can still be found in various places across the internet.
Last week I saw about 80 patients who had screened positive for either exposure to COVID-19 or possible respiratory viral symptoms; this week more of my time is devoted to working in outdoor COVID-19 testing clinics, so it will probably be well over 100. Some of those patients had been ‘caught’ by our screening questions but really had no COVID-19 exposure or symptoms; the lady with a chronic cough who was really just coming for her high blood pressure, the gentleman with a fever that was caused by an abscess under his axilla (we call it ‘axilla’ because ‘armpit’ sounds so un-doctory). I treated them too, of course. But for the most part people were seen in our COVID-19 focused clinic specifically for COVID-19 related concerns. I don’t have exact numbers in front of me, but of the 70 or so I tested for the virus, about 20 came back positive (Epidemiology note: this is too small of a sample to calculate anything like a test positivity rate or prevalence from), and there were at least a couple that, due to certain combinations of exposures and symptoms, I’m convinced had the virus despite a negative test (way, way too small of a sample to make any calculations from; please don’t go and quote me as saying that based on my sample of 2 out of 50 negative tests I think there is a false negative rate of 4% or something crazy like that)(although now that I look at prevalence estimates and test sensitivity, 4% is actually about right. Hmm…).
I called each patient who tested positive personally to give them the news and answer their questions. Amid the many questions I was asked (‘Should I go to the hospital’?; not now, but let’s talk again about red flag symptoms and emergency precautions. ‘Should I isolate from my children?’; that’s really complicated, and it depends on the age of your children, your support structure, and their specific developmental, physical, and emotional needs), one question that came up over and over again is one I sincerely wish I had a better answer to; ‘what medicine can I take to make sure this gets better?’
This is a big and important question. Doctors kind of like medicine; kind of a lot. After all, prescribing them is a big part of our job, and even though adding a medication is not always the right answer (more on this later), it is incredibly satisfying to prescribe the right medication or therapy for the right diagnosis and then see your patient get better. It can also be fairly stressful at times, because no medication (except prenatal vitamins) is perfectly safe; giving someone a medicine, especially one that wasn’t actually necessary, and then seeing them suffer because of drug interactions or unexpected side effects is devastating to a physician. We have taken an oath to ‘first do no harm,’ and we take it seriously. This is why I’ll spend 10 minutes carefully explaining to a parent about how viruses and bacteria infect the body differently and how antibiotics work rather than spend 2 minutes prescribing their child an unnecessary antibiotic for a viral illness, which would surely feel more satisfying for both of us. It is also why, as certain as I am that some of the patients I have shared the news of a positive COVID-19 test result with will end up getting sicker, and as nervous as that makes me on their behalf, I have not been prescribing unproven, untested medications out of desperation, but have instead focused on teaching those patients how to keep themselves and others safe and how to recognize the early signs of a severe infection.
It’s also why I check for new or updated studies or professional recommendations, and review information being shared between doctors and other clinicians on COVID-19 social media groups every every single. The moment that there is a proven, safe early therapy to prevent COVID-19 infections from becoming severe, I will be the first to start using it.
Dr. Richard Bartlett discovers silver bullet for COVID-19.
Last night I came across a viral video, which has since been sent to me multiple times, which seemed to promise exactly this. A doctor here in Texas went on a morning news show to discuss the 100% effective, perfectly safe COVID-19 treatment he is using to prevent severe illness in his patients. If you have any degree of medical training or even personal experience with medical issues, you are probably just as skeptical as I am about both the ‘perfectly safe’ and the ‘100% effective’ claims; few medicines are ever either. We will go through Dr. Bartlett’s interview in detail below and try to evaluate the quality of data he is relying to make these claims, and answer two questions; should you call and ask your doctor for this ‘new’ treatment, and should I call back all of my patients and tell them, much to my satisfaction, that we do have a medication I can put them on after all?
One quick note: the video is about 30 minutes long and trails off a lot into conspiracy territory concerning mandating vaccines, instituting lockdowns to destroy the economy in order to hurt President Trump’s reelection chances, and quite a few other areas. We’ve covered a lot of that before, and frankly a lot of it falls outside the realm of medical misinformation. We will try to cover the most important parts of Dr. Bartlett’s interview regarding his new COVID-19 therapy, but I won’t try to write the 10,000 words it would take for a rebuttal to all of these ideas.
Here is the video:
00:16: Midland Texas is located in Midland County, about 6 hours West of Waco (golly, Texas really is huge). With a population of 138,000, it is almost exactly the size of Waco. Just like for us and the rest of Texas, they began to see a significant increase in COVID-19 infections about 3 weeks ago. Before this, they had seen very few cases total, like most pre-surge areas. You can review their data here.
00:33: The article is here; it provides some additional details and we will reference it later.
At 02:04 Dr. Bartlett begins his discussion on COVID-19 treatment in earnest by discussing the context for the pandemic in America, namely a comparison to both nations that have fought the pandemic successfully and those who have struggled more with a higher number of infections and deaths. He begins with Taiwan.
02:07 “In the country of Taiwan there’s over 25 million people, they’re stacked on top of each other, if they did social distancing they’d be out in the ocean floating around.”
He goes on to say that there isn’t enough room to social distance, and yet the country has seen only 7 COVID-19 deaths, “as many people as you could stack in a minivan.”
The problem here, besides Dr. Bartlett’s strange obsession with stacking people, is that Taiwan has done social distancing. Dr. Bartlett goes on in the video to assert that Taiwan has foregone both social distancing measures and widespread face mask use (which he associates with Communist China). Do any reading on Taiwan’s response to COVID-19 and you will find widespread wearing of face masks and aggressive physical/social distancing measures since the earliest days of the pandemic, in addition to other mitigation strategies such as providing social support for quarantined patients to help them maintain a high level of isolation, and using mobile phone technology to perform extremely precise contact tracing. This is all in the context of a strongly collectivist culture willing to engage in such measures for the good of their neighbors regardless of official mandates, with a history of understanding the stakes in such a pandemic because of their experience with SARS in 2003.
So as Dr. Bartlett moves forward talking about Taiwan later in this video, you need to understand that, perhaps entirely unintentionally, almost everything he has said about their success in fighting COVID-19 so far is the opposite of what they have actually done.
02:41 At this point Dr. Bartlett also mentions Iceland, Singapore, and Japan, who all engaged in some combination of extensive masking and social distancing except Iceland, who used aggressive contact tracing and quarantine measures. Dr. Bartlett’s assertion that they have been successful because they have used similar treatment plans to what he uses for his patients seems entirely unfounded.
02:59 “That’s not possible according to what we’re being told in the mainstream media.”
Literally nobody is hiding this data. If you google “Taiwan COVID” you get this:
“You can even look it up in the Johns Hopkins COVID website and you’ll see those numbers. They’re hidden in there, but I’m pointing them out.”
I’m concerned that what Dr. Bartlett is doing here is contributing to a false narrative that the powers that be, especially the CDC, the WHO, and the medical establishment (i.e. he and I), doesn’t want people to have access to good reliable data. Maybe this is where Dr. Bartlett’s search for reliable information to back up his COVID-19 treatment has led him; not trusting the available information because he wasn’t able to find the scientific verification he is sure must be out there for his new therapy. Maybe this is strongly ingrained in his political position (he recently ran for office) and he is interpreting the ready availability of this kind of data through a lens of suspicion, or knows that his audience on this show will affirm the idea that this information is being hidden from them and that it is harmless to reinforce that belief. But I am always a little suspicious of physicians who want to weave these tells of conspiracy theories and hidden truths about the pandemic while promoting their own unverified findings, and part of me wonders if they are certain they will face pushback from their fellow doctors and scientists, and want to head it off at the pass by encouraging the idea that those doctors and scientists don’t want you to know ‘the truth.’ I certainly hope this isn’t the case with Dr. Bartlett, but part of me thinks it must be an easy trap to fall into without realizing it.
It isn’t Hydroxychloroquine
03:32 “(In these other countries) they’re doing what I’m doing, which is not hydroxychloroquine, although that works….
Before he reveals his miracle drug, he gives a brief shout-out to Hydroxychloroquine, stating it does work but not providing further explanation as to how he knows it does or why he doesn’t use it as well. I almost wrote today about a viral post by a doctor in McKinney Texas again promoting outpatient, widespread hydroxychloroquine use in patients regardless of test results and risk factors. We covered this pretty extensively over a month ago following his colleague Dr. Lozano’s speech at the Set Texas Free Rally in Dallas. He also claims that masking, social distancing, and even testing are ineffective. I’ve chosen to write about Dr. Bartlett’s video instead, but in terms of relying on anecdotal evidence and not understanding representative sample sizes, there are a lot of similarities. If things are quiet this week I will try to write about Dr. Procter’s social media post as well and try to tackle hydrochloroquine one last time.
I want to talk hydroxychloroquine. I want to talk about these scripts that you’re writing; Put down the pen, stop prescribing. I want to talk about what I have learned, About the research you have spurned…
The Silver Bullet: Inhaled Budesonide
03:36 “So what they’re doing is an inhaled steroid. So my silver bullet is inhaled budesonide.”
Dr. Bartlett finally reveals his miracle drug, inhaled budesonide; a commonly used inhaled corticosteroid that is commonly used for patients with Asthma or COPD.
This is the first good place to stop and look at this idea in more detail. The first two questions we need to ask when someone proposes a novel use of a medication or therapy are 1. Is there a proposed mechanism by which this would work? 2. Why did nobody else think of this (has this been tried/studied before)?
Dr. Bartlett’s rationale is that since this is an inhaled respiratory anti-inflammatory, it should work for COVID-19 which is a ‘respiratory inflammatory condition.’ Part of the problem here is that this is gross oversimplification of the virus’s pathophysiology, which is still not completely understood (see below). It is supposed to make you go “wow, that’s just common sense! It causes inflammation in the lungs, so an anti-inflammatory breathed into the lungs will cure it!” But if you reflect on whatever extent of experience you have with medicine, you will realize that things are never quite that simple. If you came to me for your severe, debilitating back pain you’ve been struggling with for years and I said, “oh I’ve got it, back pain is caused by inflammation of the muscles and joints, so I’ll give you a medicine to decrease inflammation; here’s some ibuprofen,” you’d probably lose a great deal of respect for me. You’d be right to. NSAID’s (non-steroidal anti-inflammatory drugs, like ibuprofen) may well be part of your treatment plan, but your back pain is complicated and is going to require more thorough evaluation and treatment. In medicine, you are right to beware of easy answers.
Budesonide is a common medication, as he points out repeatedly beginning in a few minutes, and I think this is actually the strongest argument against his proposed use of it in COVID-19. You read that right; I’ll explain. The usual dosing of budesonide is twice a day as a maintenance medication; by decreasing inflammation and swelling in the airways, it can eventually (it may take weeks to months) lead to less frequent asthma and COPD symptoms like cough and chest tightness, and fewer exacerbations. However, Asthma and COPD patients still have acute exacerbations despite using inhaled corticosteroids. We still see patients on budesonide in the clinic and in the hospital for acute worsening of their symptoms due to respiratory infections. Sometimes these are bacterial infections, but more often they are viral; including coronavirus species. Sometimes these patients go into respiratory distress, and sometimes die, even when the virus they have isn’t nearly as deadly as COVID-19. If budesonide was able to completely prevent viral respiratory illnesses from causing inflammatory respiratory symptoms like cough, shortness of breath, wheezing, and chest tightness, we would never see these patients getting sick from respiratory viruses; but we do, because the medication doesn’t really work that way. If Dr. Bartlett consulted his complex understanding and professional history of treating respiratory infections he would realize that his proposed mechanism really doesn’t make sense, especially as the 100% effective silver bullet he is promoting it to be.
Later in the video (around the 06:36 mark) Dr. Bartlett does talk about the “cytokine storm” in COVID-19 and prevention of the body’s own inflammatory response to the virus. Is it possible that the medication he is using, while not preventing all respiratory viral infections, at least treats this one? Without getting into the weeds too much here (the idea of a cytokine storm being the underlying cause of ARDS in COVID-19 is still controversial), we need to understand that you don’t just have this one thing called ‘your immune system’ causing this process called ‘inflammation’, so that if ‘inflammation’ (or in this case, ‘cytokine storm’) is the problem we can just suppress the immune system and call it a day. The immune system is incredibly complex, and any given immunomodulating medication is going to work on parts of the immune system (and not always in the ways we hope or expect) while not significantly affecting others. As an example, the primary cytokine implicated in the COVID-19 cytokine storm seems to be interleukin 6, a pro-inflammatory cytokine that budesonide, in previous studies unrelated to COVID-19, doesn’t seem to affect appreciably. Studies focused on medications that do appreciably decrease IL-6 activity are currently underway.
The second question, if the mechanism did make perfect sense, would be to ask whether anyone has tried this before. Dr. Bartlett indicates that it has been tried elsewhere; he states that this is what they are doing already in Taiwan and Singapore. I was unable to substantiate this; I cannot find any evidence that these nations have used anything like widespread protocols with inhaled steroids to treat COVID-19 early in the disease course. There are some ongoing trials with use of inhaled corticosteroids (not budesonide, at least that I could find), as Dr. Bartlett mentions, but there is not any data available from them yet; if they prove safe and beneficial for COVID-19 patients, we would start using them in all the clinical contexts where they were shown to be effective.
There are two other data sources we could look at. First, the most successful trial we have right now with use of steroids in COVID-19 is the RECOVERY Trial out of Oxford, which I wrote about recently. In this study patients were put on systemic steroids (dexamethasone) once they were already hospitalized. You might argue that this isn’t what Dr. Bartlett is talking about at all, that he wants to use budesonide before they are sick enough to go to the hospital. I understand that; but the study showed a reduction in mortality in both the groups needing oxygen and those requiring mechanical ventilation, but not in those who didn’t require oxygen. You can only extrapolate so much from this, but if Dr. Bartlett’s theory of the earlier the steroids the better panned out, you would expect the non-oxygen group to see at least as much improvement in outcomes as the patients who were already very, very sick; but that wasn’t the case. We need to remember that even though our first successful randomized drug trial for COVID-19 is indeed a steroid, the role it plays is complex and the benefits limited to certain clinical scenarios; the data still shows that immunocompromised patients, including those on medications that modulate the immune system, are at a higher risk for COVID-19 than those who aren’t.
We can also look at the two closest viruses to COVID-19 that we have experienced, SARS in 2003 and MERS in 2012. These are both Coronaviruses that seemed to involve a ‘cytokine storm’ causing acute respiratory distress syndrome. During these outbreaks inhaled corticosteroids were used more widely, but results were mixed; there was no strong evidence of benefit, and some evidence of worsening of the disease, including increased risks of secondary bacterial pneumonia and prolonging the time it took for the body to clear the virus.
Edit: When discussing this issue, a colleague also pointed that this idea of ‘what about decreasing inflammation in the lungs’ is not novel, and studies have tested inhaled corticosteroids on practically every lung infection (infection is a very pro-inflammatory state) over the past 30 years, not just SARS and MERS. Results have been extremely unimpressive, but there has been consistent evidence of increased risk of certain types of lung infections, including tuberculosis, non-tuberculosis mycobacterium infections, and severe drug-resistant bacterial pneumonia.
So I’ll conclude this section where many people with much more expertise in this area than myself have, by saying that the balance of risks and benefits still doesn’t justify use of an inhaled steroid in people without asthma or COPD who are already taking one or would benefit from one anyway. There is no reason to believe that they will appreciably decrease the chances of developing the severe acute respiratory distress syndrome that makes the virus so dangerous for some people, and for the vast majority of people who will do fine with their own innate immune system fighting the virus, steroids would potentially increase both the risk of worsening infection and delayed clearance of the virus, and the risk for associated bacterial infections (in addition to a host of other potential side effects). If we were to begin using this in patients who don’t have COVID-19 as prophylaxis, we could conceivably increase their likelihood of getting the virus. The mechanism of causing these types of harm is at least as strong as the proposed mechanism of preventing worsening of the disease.
03:46 “It’s super cheap, it costs about $200 for the total treatment if you pay cash.”
I understand that he is probably intending this as a comparison to a hospitalization for COVID-19, which is disastrously expensive, as he truly believes the budesonide will prevent hospitalization. Still, all I can say is that Dr. Bartlett and I have different ideas about what constitutes super cheap medication; most of my patients could not afford a $200 medicine.
“But what does all of that matter? He said it is working for his patients.”
There are some more problematic statements in this video, including the idea that our numbers in Texas are only going up because of increased testing (17:05), revisionist statements that totally invert the sequence of events and thus cause and effect of social distancing and masking measures in the most affected countries (21:50), a troubling statement about Japanese people ‘crawling all over each other in Sushi bars’ (22:55), and strangest of all, repeated statements about how waiting to treat someone until they have symptoms is un-American, whereas early treatment is the American way (both preventative and acute care are part of every healthcare system in the world; there is nothing particularly American about throwing medications at people before you know whether or not they need them).
I hope to update this post with some rapid-fire answers to these issues later, but I want to focus here, for now, because I sincerely believe this is the part of Dr. Bartlett’s interview that people find most convincing.
“One hundred percent of my patients are alive. I’ve been treating this since March.”
I’ve written before about the dangers of anecdotal evidence. I think as physicians we are prone to fall into this trap for a couple of reasons. One is because we want so badly to help our patients, and if we hit on a medication that really feels like it is working, it’s hard to let go of that feeling. Another is because we spend so much time thinking about our patients and working for their well-being that their stories loom very large in our minds, and it’s easy for the relative importance, as data, of our personal small numbers of cases to become overinflated. With that in mind, I think it’s worth looking at Dr. Bartlett’s evidence from the outside and asking whether it really has the value he credits to it.
According to the local news article featuring Dr. Bartlett back on May 21st where he first publicly called budesonide his ‘silver bullet’ against COVID-19, at that time he had treated 12 people. Twelve. This is an incredibly small sample size, but we could hardly expect larger; Dr. Bartlett is not the only doctor in Midland, and throughout March, April, and May the entire county only had 1 or 2 new cases of COVID-19 most days; there just weren’t that many COVID-19 patients to go around. Dr. Lozano had previously gotten around this issue by saying that she wasn’t even testing, but was treating empirically based on symptoms or possible exposure, which doesn’t really make sense in a pre-surge area with incredibly low prevalence. Dr. Bartlett has stated that he believes in testing, and although his comments are mixed on whether he is treating only confirmed COVID-19 cases with budesonide, I think we could credit him with such qualms. Twelve cases over 3 months is an extremely small sample size, and it is important that we understand that this is not coming from someone who has been inundated with COVID-19 cases like our peers in New York; at the time that Dr. Bartlett decided that budesonide was a miracle drug he had practically no experience with the virus. It is certain that his numbers have come up by now, with cases rising all across Texas; but with lag time between exposure and the onset of symptoms, and a second lag between the beginning of symptoms and severe respiratory complications, it is not possible to say that all of Dr. Bartlett’s recent COVID-19 patients are out of the woods yet.
So Dr. Bartlett’s first error is over valuing the data from his sample size, but his second error is in thinking this disease is more dangerous than it actually is. I know that seems like a strange thing to type; the disease is plenty dangerous, and I have encouraged the utmost caution on this blog more times than I can count. We have looked over and over at the hundreds of thousands to millions of lives that might be lost if we do not discover effective drug therapies and if the virus continues to spread unabated because of poor adherence to mitigation strategies like face masks and physical distancing. But the virus has never been estimated as having a 20% fatality rate as Dr. Bartlett says in the video. Dr. Bartlett has no doubt been worried about COVID-19 since March, just like me. Just like me, he probably has friends and classmates working in ER’s and hospitals in New York and New Orleans and other areas that have already been hit hard, and has heard the horror stories about what this can do to both individual patients and entire healthcare systems. Like me, as soon as he started thinking about this respiratory virus he probably immediately thought of the names and faces of two dozen patients that he was particularly worried about. Due to this anxiety, surviving the virus has become, in his mind, the exception rather than the rule. We see this in his account of the woman battling cancer; he says “she should die according to what you hear from the CDC and the WHO,” even though we know that COVID-19 is not universally fatal for any group. By increasing the danger of the virus in his mind, or at least increasing the probability that any given patient will go to the hospital or die, it makes it seemingly unlikely for people to get better without some specific intervention, even though we know that is what happens most of the time; thus the interventions he has chosen (budesonide, zinc, antibiotics) receive the credit for his patients’ recovery.
Put these two biases or statistical errors together and it may be easy for a physician to believe, based on the slightest of clinical experience with this virus, that he has discovered a cure. Each patient you treat this way will confirm it for you, as long as they get better, even if they would have gotten better anyway, and particularly if they tell you they feel better right away, which is such a wonderful feeling even if it doesn’t always correlate to their eventual outcome. If you are willing to loosen your treatment criteria to include people who have had no test or negative tests, or who are fully asymptomatic as Dr. Lozano seems to have done with hydroxychloroquine, you can inflate your treatment numbers even higher. And if you top-out at something manageable for a small-town physician, say in the low 100’s, you might never see a fatality from COVID-19. Imagine that we were back in May when Dr. Bartlett had only treated 12 COVID-19 patients. He states boldly that 100% of his patients were alive, yet we think the death rate is around 1.3%. If just one of his 12 patients had died we might still find this convincing because we are so easily swayed by anecdotal evidence, but that would have been a fatality rate of 8.3% in his budesonide patients. We would have fallen into the same trap as Dr. Bartlett, of picturing those 12 patients heading toward certain demise and all but one rescued by his treatment plan, without which they would have died, when in reality there is no evidence to suggest that they would have been any worse off without the treatment. Dr. Bartlett’s experiences with the virus so far are exactly what we would expect without budesonide and antibiotics.
“Look, he says it is helping his patients and you don’t have to use it for yours, so why does it matter to you?”
Great question, hypothetical person who keeps arguing with me on the internet. Any time we begin talking about someone’s personal experiences, the temptation is to treat their narrative as incontestable; I wasn’t there, I didn’t see his patients, so I don’t have the ability to second-guess his clinical judgement. In a way this is actually sort of fair; Dr. Bartlett had just as many years of medical school and residency as I did, and has many years more clinical experience, and to some degree each physician has earned a degree of professional trust to practice in a way we see fit with accountability only to ourselves and our patients, at least in many circumstances. But we know that this professional leeway has been abused in the past, and even in the absence of abuse of that privilege, lone-wolf medicine is a real problem because by it’s very nature it is disconnected from one of the best tools we have to improve our clinical abilities and correct our errors; the honest feedback and accountability of our fellow doctors. If a physician feels that a patient’s clinical situation calls for a unique approach that is not supported by evidence, this can often still be tried as long it is accompanied by an honest and careful explanation to the patient of the reasoning behind this approach, the unproven nature of the treatment, and the risks involved. If we begin to make a habit of such practices, and particularly if we do so ignoring the voices of our peers around the world saying we’ve tried this before and it didn’t show reliable results on a larger scale, or the voice of researchers and scientists saying that doesn’t actually work the way you think it does, then we are doing so at our own, and more importantly at our patients’, peril.
In many ways I think Dr. Bartlett is actually going about this fairly well. He seems to imply that he is using the medication, which does have a theoretical mechanism of action after all, only on those who really do have COVID-19. He does not seem to be doing television interviews or talking with newspapers in order to make a name for himself and attract clientele from all over the state to help his business, as seems to be the case with some other doctors prescribing unproven treatments, but in order to ‘get the word out there’ to other doctors (as one of those other doctors, I deeply appreciate this impulse), although I am not sure why he has not utilized any of the many avenues on social media that many of use are using to get physician specific feedback and share ideas; maybe he is and we just aren’t part of the same COVID-19 doctor groups. Most importantly, he states that he has written and is submitting a paper for publication, which will provide both more details about his patients, their demographics, commodities, and clinical presentations, and allow for peer review and a higher degree of detail and scrutiny than we could possibly get through a TV interview.
But there are at least three ways (besides the tacit endorsement of several conspiracy theories) that I find Dr. Bartlett’s approach truly troubling. First, he is not presenting his treatment plan as an entirely unsubstantiated experimental approach driven by hope and a hunch, which is what it absolutely is, but as a “Silver Bullet” that is perfectly safe and cannot fail, which is certainly is not. One would hope that this is bravado or enthusiasm for the TV audience and not hubris; in other words, we have to hope that whatever confidence in his treatment regimen he shows in this interview, he is still very carefully explaining to his patients the limitations of his evidence and the potential risks they are taking on if they use it, and the red flags to look for in case it doesn’t work.
Second, he is not just promoting his unproven treatment but also discouraging mitigation measures, such as physical (social) distancing and wearing masks, that actually have been proven to save lives. It is unclear whether he believes the misinformation around these strategies not working or is just so confident in his treatment approach that he no longer thinks they are necessary, but the effect will be the same; as Dr. Bartlett’s video goes viral there will be increased pushback against wearing masks and observing distancing measures by those who find him convincing, which will ultimately lead to more cases, more hospitalizations, and more deaths. His evidence is too weak and his scientific rationale too shaky to convince a conscientious doctor to start using his treatment approach; but he speaks with enough confidence and sincerity to convince some people on the fence not to wear masks. The net effect of his interview, like any viral misinformation, is to make the pandemic more dangerous for everyone.
And third, by presenting his treatment plan as something that it isn’t and ascribing to it all of the confidence and reliability of a truly proven treatment, he is spreading misinformation that blocks out the transmission of reliable information for the public and pollutes the relationship between his listeners and their own doctors and healthcare systems. When I explain to patients that I do not have a proven medication I can in good conscience prescribe them to prevent their COVID-19 from progressing, their exposure to voices like Dr. Bartlett’s, Dr. Lozano’s, and Dr. Procter’s have already sewn the seeds of mistrust in the information I am providing, and they are less likely to believe the other recommendations I am carefully trying to give, such as isolating within their home and monitoring for red flag symptoms, and the reassurance I am trying to provide to alleviate their fear and anxiety as we discuss their individual chances of having a severe course of the virus. It may lead anxious patients to seek additional visits elsewhere and shop for a doctor that will prescribe them what Dr. Bartlett says they need, further increasing their chances of exposing others and potentially increasing the costs associated with their medical care, both to them personally and to an already strained system. It may even lead some patients, convinced by these doctors and desperate for medicines they now believe are their only hope of beating the virus, to misrepresent their symptoms in ways they think might push their doctor into prescribing them.
When lone wolf doctors promote unproven therapies and set themselves up as experts with miracle cures, without having actually done the clinical research to validate their claims, it erodes the fragile trust that we work so hard to build with our patients when we are unwilling to engage in that same type of speculative treatment. This unearned mistrust has the potential to breakdown the patient-physician relationship and affect our patients’ health for years to come. Millions of doctors, nurses, and other medical professionals around the world are working as hard as we can to both care for our patients in the midst of this pandemic and stay up to date with the latest diagnostic and treatment options. Viral voices drowning out the excellent work that is being done researching potential treatments, and calling out any doctor not willing to follow their lead, should humbly re-evaluate their limited clinical experiences in the face of this global pandemic and bring forward their innovations, not with less hope or enthusiasm, but with much more care and a realistic appraisal of the strength, or lack thereof, of their evidence.
A friend sent this video my way along with some questions from a family member. The questions were of a specific and limited scope, which I deeply appreciate, and I hope I will have answered them satisfactorily within this post. The video is of Dr. Ivette Lozano, MD, who is general surgery trained and now runs a solo general medicine practice in Dallas, an hour and a half North of where I work; I am not sure whether she also works in surgical and/or hospital settings, as this information is not available from her website and does not come up in the video. She was speaking at the Set Texas Free Rally in Dallas on May 9th. Dr. Lozano has done numerous interviews and television appearances during the COVID-19 crisis and has these collected on her practice website; though I will keep commentary focused mainly on the video that was sent to me, watching her other interviews has been helpful in understanding her experiences and position more clearly, and I will refer to those at certain points as well. I do not feel that it would be appropriate for me to link to her practice website directly from a blog post that seeks to discredit and contradict so many of her claims, but if you wish to see her other interviews they seem to be available on YouTube.
I’d like to point out two things about this video right from the start. First, unlike the personal youtube videos we have looked at so far and and the extensively produced PlanDemic documentary, Dr. Lozano is speaking in a live, outdoor forum without the option of editing or multiple takes. She speaks for 13 minutes and seems to consult her notes very infrequently, if at all. That in itself is an impressive feat. I’ve spoken at this type of gathering a few times as a professional, sometimes on very little notice, and I honestly can’t remember half the stuff I said afterwards; it’s just not the most conducive to an academic discussion. With that in mind, if Dr. Lozano does ere in some finer details or specifics, I think a measure of grace is called for; in such a setting, it would be at least as likely that such an error were due to the challenges of that context and not to design.
The second is that Dr. Lozano states multiple times (and we will examine these instances more closely as we come to them) that she is speaking from her own personal experiences. In common experience this tends to serve as a rebuff to any attempts at correction or argument. I do not mean that this is Dr. Lozano’s intent; I only mean that we need to point this out now to preempt any blanket objection to a thorough evaluation of her claims with such phrases as, “well she is sharing her own experiences, so you can’t argue against that with statistics or outside information. She is just telling her story.” In scientific pursuits, and in her role as a physician, her statement that she is relying only on her own experiences should properly be understood as her ceding that her evidence, while compelling to her personally, is in fact anecdotal; that is, based on a small sample size that has not been studied rigorously and is not likely to represent an entire population. Dr. Lozano, as a clinician and scientist, would no doubt understand this.
Anecdotal evidence is important in medicine. It serves as a jumping off point for examining trends and leading to more rigorous research, and as an anchor for contextualizing results and treatment guidelines. In absence of anything better, we rely on our own limited experiences in treating patients; but the principles of evidence based medicine also dictate that, as scientists, we rely on stronger forms of evidence when they are available. If that evidence seems to contradict what we ourselves have experienced, that is reason to both examine the evidence more carefully, and to reflect on our own clinical experiences with a greater degree of scrutiny and honesty. Most often there are factors at play that our limited experiences and volume of data simply cannot reveal, and once we account for these our own experiences really do harmonize with the evidence after all. In fact, it’s fair to say that, to a large degree, what we call high quality evidence is really just the experiences of many, many physicians and patients aggregated and then evaluated rigorously; we ignore the experiences of many in favor of our own individual narratives only at great peril to ourselves and our patients.
So, as we look at these claims, please do not fall into the trap of thinking that as personal experience her claims are exempt from contestation. That is a legitimate and important way to interact with individuals in a great many contexts, and listening to people’s stories without judgement is a vital part of what I do every day as a physician; but it is not the way either Dr. Lozano or myself have been trained to think of medical data.
00:18 “I am currently treating COVID patients in my office.”
I am, too. It is important when we talk about our own anecdotal experiences that we at least give some idea of volume. I have interacted with only a few COVID-19 + patients; our county and city has had a blissfully small burden of disease from this virus and has not yet hit anything like a surge. Dallas, a much larger metropolitan area, has been hit harder, and I would readily believe that Dr. Lozano has seen more COVID-19 patients than I have personally; though she does not here give an indication of the number of cases she has personally treated. Yet, Texas also has had relatively few cases, and so both of our experiences would pale in comparison to those of clinicians in New York, Wuhan China, Italy, Spain, etc. We need to have the humility, as doctors, to recognize that our own small samples cannot lead to definitive clinical data on their own.
00:25 – 1:23 “Let’s start with some simple numbers.”
330 million in the US
29 million in the State of Texas
2 million people in Dallas
Dr. Lozano: “When you see those numbers it kind of shocks you, that we could stop society for one hundred and eleven deaths.”
So here is my first objection. The Number of deaths in Dallas County, 111 (now 145), has nothing to do with two things. First, it has nothing to do with the populations of either the entire United States or of the State of Texas. If you want to include those numbers, your data set would look something like this:
Population 330 million
89,932 Deaths from COVID-19
Population 29 million
1,336 Deaths from COVID-19
Population 2 million
111 Deaths from COVID-19
If you are not going to include the number of deaths (underestimated though they may be) in the US and Texas, why include those populations? I believe it’s simply to make the 111 deaths in Dallas seem small in comparison. I could do this in Waco, too; I could stand up at a rally and say “the population of the US is 330 million, and there are 257 thousand people in McLennan Country. We’ve only had 4 deaths. Are we really going to shut down all of society for 4 deaths?” It sounds pretty silly doesn’t it, to invoke that 330 million people without mentioning the 90 thousand lives lost among them?
Now, maybe it sounds like I am splitting hairs, but this is important; the reason that we shouldn’t invoke population numbers detached from death numbers is because the 111 deaths in Dallas also has nothing to do with shutting down Dallas. Think about that for a moment. Cities, States, and Nations that were not hit early by the pandemic have had the privilege of developing their response based on the impact in other places. Shutting down Dallas wasn’t based on 111 people in Dallas losing their lives to COVID-19; it was based on over 15,000 deaths in New York, 27,000 deaths in England, and 32,000 deaths in Italy. It was based on the recognition of what this virus can do to a city or a region, particularly once the healthcare infrastructure is overwhelmed. In fact, in saying that Dallas was shutdown because of only 111 deaths, she is exactly reversing the logical relationship between those ideas; the reality is that there have likely only been 111 deaths because Dallas was shutdown.
Dr. Lozano goes on, “here is how it is notified to you:”
27,000 Positive Covid Tests (??? but probably Texas)
3,000 Recovered (???)
111 Dead (Dallas)
“If 3,000 have recovered, from 127,000 (???) positive tests, that’s 124,000 that have recovered.”
Now it’s clear that Dr. Lozano misspeaks here, either with the 27,000 or the 127,000 above; please remember, she is speaking in a very challenging format and such things happen. However, I honestly cannot tell which is the statistic she intended. Looking back at data from May 9th, Texas had around 37,000 positive COVID-19 cases and 1049 deaths, but listed 19,000 as recovered, not 3,000. Dallas had 111 deaths but to date has only had about 6,000 confirmed cases total, and the US was already in the millions of cases by that time. So, without knowing where her numbers have come from, it’s a bit hard for me to fully examined the claims she is making, but we can safely make at least three observations.
First, she is now directly comparing the number of cases in Texas (the 27,000 above; I cannot imagine where else this number could have come from) to the number of deaths in Dallas only, without mentioning the number of cases in Dallas at all. This is deceitful use of statistics and I sincerely hope it was accidental. Second, her point seems to be that the public is being lied to about the number of cases that are recovered; “27,000 cases, only 3,000 recovered.” But this is not the case; at the time of her speech, official data placed those numbers at 37,000 cases and 19,000 recovered. Third, her final conclusion (here she misspeaks again but her intent is clear) that the number of cases minus the number of deaths equals the number of recoveries is erroneous both because we do not yet know the long term ramifications of the disease, and more to the point, because there are still over a million people with the illness in the US who have not yet recovered. Most of them are at home under close observation and follow-up, but many are fighting for their lives in the ICU and are by no means ‘out of the woods’; some of these people are in the ICU in Texas, and we cannot discount their struggle and the suffering and danger they are still facing. Some will still die, despite the best efforts of their doctors and nurses.
1:23 “I don’t want to bring statistics from other physicians because there is always someone on the Left who wants to contradict me.”
This is the portion of the video where Dr. Lozano begins to speak about her personal experiences, but I want to spend one more moment on this very troubling statement. The politicization of COVID-19 within the medical field is largely a false narrative, and not a particularly coherent one. We’ve talked about this a lot on this blog, on multiple occasions, but basically the conspiracy theorists would like you take any doctors you happen to know and trust, or who share their conspiracy theory, and put them in the “one of the good ones” box; the few honest doctors fighting for the truth. All the rest of us, even if we happen to share your background or faith or even political leanings, are to be put in the “part of the system” box and seen as either infamous conspirators or unwitting patsies. We are, so they argue, inflating death numbers, scamming medicare, and lying to the public in order to… do… something. This part isn’t really clear, you see. Despite the vast scope of different political allegiances, backgrounds, economic views, and personal convictions among doctors, we are all somehow part of a conspiracy to destroy the economy, embarrass Donald Trump, bring about a totalitarian police state, enact socialism, etc. Despite many docs I know getting all of their news from Fox, despite some being close to retirement and watching their 401k’s like hawks, despite many having voted for Trump and planning to again, despite the fact that we are not a monolith. Despite the fact that we have had to work extra hard to take care of our patients in the midst of a pandemic, and the fact that many of us have gotten sick, and some have died, doing so. Despite the fact that, a few minutes later, most conspiracy theorists will point to empty ER’s and closing doctor’s offices in non-surge areas as a sign of the economic injury being done by mitigation measures, their conspiracy theories still call for those doctors struggling the most financially to be a part of a conspiracy to propagate the COVID-19 myth. It’s all rather silly, I’m afraid.
Which is why it is so alarming to see Dr. Lozano adopting it here. What she is saying is that she is only willing to rely on her own anecdotal evidence in talking about and treating COVID-19 because she believes that the experiences of her colleagues and higher quality data from research hospitalsaround the globe are skewed by a Leftist political agenda. This is a very, very dangerous way to practice medicine. At best, Dr. Lozano knows her audience and is willing to let them believe in these conspiracy theories in spite of her knowledge of the way medicine actually works, and the devotion that the overwhelming majority of doctors have to both veracity and the health of their patients regardless of their own political leanings. At worst, she has come to believe in this perverse and pessimistic view of physicians herself. My fear is that this perspective ultimately leads to practicing ‘lone wolf’ medicine detached from evidence, the insights and experiences of peers, and the commiseration and accountability that come from serving within this ancient and altruistic profession.
But because this Southern, Homeschooled, Eagle Scout, 4-wheeler-riding (is that still a conservative credential?) future-missionary-doctor has seen the compassion, the integrity, and the seemingly endless self-sacrifice of fellow physicians from every walk of life and all parts of political spectrum time and time again, I cannot be so quick to attribute to them nefarious political motivations capable of overwhelming their commitment to their calling and Oath. So when discussing Dr. Lozano’s anecdotal evidence, I will be relying on something more substantial than just my own.
1:48-2:05 Discussion of Symptoms
Here Dr. Lozano is discussing the patients with COVID-19 she has seen in clinic. I only point this out to note two things moving forward; first, she does not give us the number of patients she has actually seen in clinic who have the diagnosis. Second, her description of symptoms is interesting. She describes fever, but only fever at nighttime. She describes cough, but only with deep breaths. These are very specific qualifiers and do not exactly match what is known from observations of millions of cases of COVID-19 around the world. Many patients have cough, but not necessary only with deep breathing. Many patients have fever, but not necessarily only at nighttime. To me this suggests that Dr. Lozano may have seen a relatively small number of COVID-19 patients, because there does not seem to be much variability in the presentations she has encountered. It also illustrates the danger of relying on anecdotal evidence alone; once we have cemented a narrative that says this disease will always act like I have personally seen it act before, we put ourselves at risk of delaying the proper diagnosis or missing it entirely. We must learn from each other.
2:06 “These patients are afraid.”
This is true. One of the most important tasks we’ve had as physicians, and really as an entire healthcare field, has been to speak to the fears of our patients in the face of this very dangerous pandemic and help them navigate their medical and mental health needs with safety and confidence. This is an important part of our conversations with patients on every level, from individual encounters to entire populations. Every patient I see who has been exposed to the virus or who has symptoms that might be consistent with COVID-19 needs both reassurance and anticipatory guidance; they need to know what happens next, how to stay safe and keep their loved ones safe, and when they need to seek additional care. Our clinic system has instituted countless measures both to support our COVID-19 patients and to ensure that our patients know they can be safely seen for their chronic conditions as well, from telemedicine systems being built in a matter of weeks to patients being seen in their vehicles so they don’t have to enter into healthcare spaces, and a thousand small steps that probably go unnoticed but reduce our patients’ potential of being exposed to the virus. As physicians, we must combat fear with our compassion and the trust we have built with our patients; never with minimizing their concerns or spreading misinformation.
But Dr. Lozano then goes a step further. At 2:25 she states that the patients who are coming to see her for COVID-19 symptoms are being turned away from the emergency room.She says they are being sent home if they have a fever and told to quarantine, and that during that time they infect their families. She says that doctors are closing their doors and implementing telemedicine, which she considers a scandal because it does not involve a physical exam. She says near the end of the video that they are having patients ‘see their assistants’ instead, implying that they are having Nurse Practitioners and Physician Assistants take on risks they aren’t willing to themselves (and playing to the undeserved discrimination those professionals face in healthcare).
At 3:17, she says that other doctors are hiding in their fancy homes with their fancy cars in the midst of a pandemic, and the contempt for others in her profession is evident in each syllable she pronounces.
Her implication is that doctors are scared of the virus and are too timid to treat their patients; they are refusing to see people, the ER is turning people away, and they are using telemedicine and other tricks to avoid having to give compassionate care that might put themselves in danger from the virus. And if that’s true, it’s a tragedy; it represents the deepest betrayal of our Oaths and the values we hold in common as physicians.
But thankfully, it’s not true. When I heard her say this I really had to grieve for a moment; grieve for a doctor whose experiences and views have so detached her from the rest of her profession that she could hold, and promote, a view of physicians that is such a stark contrast to the reality. Please take a moment and really, honestly compare her narrative to the stories you are hearing and seeing from doctors all over the world; the doctors who are staying in donated hotel rooms or sleeping in the hospital call room between shifts because they are too frightened of the virus infecting their own families. Notice that they aren’t cancelling or no-showing their shifts; they are still taking care of patients every day, placing themselves in harms way and risking their live for others as they have been called to do, but they are also taking on the sacrifice of isolation themselves in order to protect those they love. Consider the doctors, even very old doctors who have come out of retirement to help and young doctors still in residency, who have gotten sick and died in the line of duty. Her narrative, at least on the physician side, doesn’t match the reality. And as much as I love my fancy car (it’s a motorcycle with a sidecar I bought used my first year out of residency; I’ve wanted one ever since I watched Indiana Jones and the Last Crusade as a kid and I’m immensely proud of it), her actively promoting for her audience the myth that most physicians lead lives of extravagant wealth (sidecar motorcycles not withstanding) is not only disingenuous but extremely mean spirited. Many of us are currently drowning in medical school debt.
But what about the patient side? Are patients really being turned away? Well first of all, it’s not only bad business and bad medicine but actually illegal to be denied treatment for an emergent condition at an emergency room. Moreover, in practice I’ve never even seen it done even for non-life-threatening conditions, and in fact one of the biggest problems with our healthcare system is that this means a great many people get all of their care from the ER because they don’t have access to a primary care doctor (when my residency program was founded 50 years ago, this was one of the problems it was created to address). Again, Dr. Lozano’s narrative seems to be the exact opposite of the real situation. From her comments alone you would think that patients with cough and fever were having the doors barred from entering their clinic or the ER; but in many areas that have been working under the assumption that a COVID-19 surge was imminent, most clinics and hospitals have deferred a great deal of other types of care in order to specifically care for large numbers of people with those exact symptoms. We have worked very hard to ensure that our other patients are still getting close follow-up, and things like telemedicinehave been put into place to make sure that my 95 year old patient with COPD and congestive heart failure can still get seen without being exposed to the transmission risks inherent in a clinic waiting room. No, patients with cough and fever are not finding a series of doors slammed in their faces, with Dr. Lozano being their last hope; but that isn’t what she’s actually saying.
4:05 Treatment for COVID-19
I promise we’ll get somewhat political momentarily, at least in the sense of giving governing officials their due while not ascribing to them godlike mastery of all intellectual disciplines, and of honestly reflecting on the merits and limitations of national and state medical associations. But let’s press on for now.
When Dr. Lozano was speaking of the patients being sent home and turned away, it might have sounded, to the casual listener, as though she meant they had been refused care, which has certainly not been the case. She tells us what she really means beginning at 5:12–6:30, and I’d encourage you to listen carefully again, and then I’ll explain the sequence of events she is eluding to.
The patients she is referring to were seen. They were evaluated. They were not sick enough to be admitted to the hospital. Because there is no specific medication that has been proven (by large scale studies, not individual anecdotal evidence) to be effective in an outpatient setting, these patients were not prescribed specific therapy. They were likely given recommendations for symptomatic treatment, instructions for self isolation, and guidelines for seeking out a higher level of care if their symptoms worsen; though the thoroughness of those discussions often depend on the time available, the practice style of the clinician, and the degree to which the patient is interested.
So far, this has actually been perfectly appropriate care. Please keep in mind that the hospital is not a place you want to be unless you absolutely have to be. Most patients (85%) with symptomatic COVID-19 have a “mild course.” This can be anything from a mild cough to significant flu-like symptoms which can be very uncomfortable, but most patients with the viral syndrome will not need to be hospitalized. Filling up hospitals withpatients who do not need to be there is the wrong decision not just for other patients in the hospital, those who might need to be hospitalized later, and for hospital staff, but also for the patient. It puts everyone at risk, including that patient, and it’s irresponsible. Dr. Lozano states that they were ‘sent home to quarantine, exposing their families’ as though this were a scandal. First of all, if these patients were symptomatic, their families had already been exposed. Second, home is where they would be safest and best taken care of unless they actually needed hospital level care. And third, there are no other viable options. Certainly some countries have set up mobile containment hospitals for mildly symptomatic COVID-19 patients to stay in until they are deemed non-contagious. Please ask yourself if that is something Americans would consent to; being told that even though their symptoms are mild, they cannot be trusted to keep from spreading the virus to others and are not allowed to return to their homes. We can’t even get people to wear masks.
Finally, these patients come to Dr. Lozano, who gives them a prescription for hydroxychloroquine and some unspecified antibiotic shots for good measure. It is now clear that way back at 2:25 when Dr. Lozano said these patients weren’t being treated, what she was really saying was that they weren’t being treated exactly the way they wanted. Now, we could go off on a rabbit trail about antibiotic stewardship and doctors prescribing antibiotics, and other medications, unnecessarily for viral conditions because it makes their patients feelthatsomethinghas been done. It builds loyalty, it gives them confidence in you, it keeps them coming back to you for minor conditions because they know you’re going to give them something for it; it does everything except actually treat the virus. Please keep in mind that in over half the viral misinformation videos we’ve seen, this is exactly what doctors are being accused of, despite the fact that most of us fight very hard against this exact mentality. It is much, much quicker and easier (and more lucrative, under many practice models) to tell a patient that the injection you are giving them will make them feel better than to carefully, patiently explain that their own immune system will defeat the virus, that there are no specific therapies but lots of things you can do to try to feel better in the meantime, and that your duty is to “First Do No Harm” to them, including prescribing unnecessary and potentially dangerous medications. The latter, in addition to taking more time, also feels unsatisfying to both the patient and the doctor; it’s also the right thing to do. If your doctor never refuses a single thing you ask for, you probably need a new doctor.
What about hydroxychloroquine?
You should know that no medicationis “considered a candy” or “a vitamin” (except, you know, actual vitamins). All medications have potential side effects and hydroxychloroquine, while relatively safe, should not be used without a specific indication and a careful evaluation of the risks and benefits. No medicine should.
But even allowing for Dr. Lozano’s waxing a bit eloquent in what comprises the bulk of her arguments in this video, we need to ask some very basic questions about hydroxychloroquine. First, we need to ask whether it works, and second, we need to ask whether her narrative and claims about the medication are true.
Does hydroxychloroquine work?
Because Dr. Judy Mikovits brought up the idea that doctors were being stopped from using hydroxychloroquine in the PlanDemic documentary a few weeks ago, I’ve written about this just recently. In the interest of length I will not reproduce those reflections here. The long and short of it is that the medication showed some promise when it was first used on a small number of patients, and following this it was used widely and we all hoped it would be incredibly effective; but unfortunately subsequent more rigorous trials and widespread physician experience have not shown this to be the case, and now it’s use in COVID-19 has been widely abandoned. For more details, please refer to the section titled “Hydroxychloroquine is a miracle drug” from the blog entry “The Paradoxes of PlanDemic,” or read this article from the New England Journal of Medicine that explains this all in greater detail, and the rationale by which the authors have chosen to stop using the medicine to fight COVID-19.
Claim: Donald Trump taught doctors to use this medicine…
While I’m afraid that I have to consider Dr. Lozano’s claims here to be politically motivated and revisionist, in the interest of fairness I admit that, depending on her individual experiences, what resources she has been using, how she acquires new medical information, and to what degree she was pursuing treatment guidance early in the pandemic, from her own perspective the sequence of events could conceivably appear as she has described them. The French study that originally established the efficacy of hydroxychloroquine for COVID-19 was released in mid march, but there was talk of it being used even prior to this; an article coming out of Wuhan, China was published on March 9th, and by the time of the March 19th press conference where Donald Trump recommended it, all the doctors I know had been talking about it in multiple forums for over a week. I had discussions about it in person and on zoom calls, over text and e-mail, and on social media both on friend’s Facebook walls and in private physician COVID-19 groups. Unless you weren’t paying attention to emerging COVID-19 information (and I think almost all of us were by that time), the president’s mentioning hydroxychloroquine for COVID-19, while certainly contemporary to the discussion, was not breaking news. Though Donald Trump was touting the medication with his usual unmitigated bravado, at the time a lot of us really did feel cautiously hopeful; we really wanted the treatment regimen to be universally effective and live up to the hype as well. We also agreed with Dr. Fauci, who stated that this study was little more than anecdotal, and while promising, shouldn’t be relied on as empirical evidence. This wasn’t a political statement; he was merely bringing to Donald Trump’s enthusiastic endorsement the temper and nuance we would expect from a medical professional. If Fauci’s later being proven right adds fuel to the political fire, it is merely a reflection of how unfortunately politicized this pandemic has become; to medical professionals, the rise and fall of hydroxychloroquine is a normal part of the scientific process, though expedited quite a bit by the pandemic.
But Dr. Lozano goes a step further than even Dr. Mikovits; she really seems to be implying that Donald Trump somehow came across this information on his own. While I understand that is a hallmark of diehard supporters of the president, the desire for him to be the smartest in the room on every subject, the idea that he was personally reviewing medical journal articles and came across this French study independently is really very silly. Of course this information would have been given to him during a briefing by his medical advisors, the same ones who then had to qualify his statements, and the very “bureaucrats standing next to our president” Dr. Lozano later decries for “thinking they know more about medicine than I do.” Notice too this strange juxtaposition; she is willing to stand on her professional pride when confronting Fauci and other advisors to the president with medical backgrounds calling for caution with the medication, calling them ‘bureaucrats’ despite their training; but she is eager to say that the president has taught her how to treat COVID-19.
….while medical societies gave no treatment guidance.
As I’ve said, this French study was published and read and discussed widely in the latter half of March, and many medical associations and news sites offered reflections on it. Treatment regimens were included in the original study, so Dr. Lozano’s saying “you would think I would get some kind of guidance from the American Medical Association” couldn’t refer to needing a hydroxychloroquine dosing schedule, but rather expert opinion on what to do with that already available information. As Dr. Lozano requested, that guidance came out on March 25th. The American Medical Association offered a very measured response, calling for physicians to weigh the evidence carefully and to be ‘just stewards’ of healthcare resources. They reiterated that the French study had been small and only included hospitalized patients, and that medications should always only be prescribed due to an appropriate medical condition. This was in response to reports that some doctors were ordering prescriptions of the medication “for themselves, their families, or their colleagues,” and that some organizations were stockpiling the medication. Indeed, there were reports at the time that some patients with Lupus and Rheumatoid Arthritis were having trouble getting their normal dose of the medication because of this. You can read the AMA’s joint statement with the American Pharmacists Association here; it has since been updated, but a summary of the original from March 25th is also online here.
Claim: Doctors are too scared to use it because it isn’t FDA approved.
The FDA actually issued and Emergency Use Authorization to treat COVID-19 with hydroxychloroquine on March 30th. This is still in effect. The FDA has since issued safety guidelines which also cautioned against its use for COVID-19 outside of the hospital. This is because the medication has many possible side effects including prolonged QT syndrome, which can lead to sudden cardiac death, and because even early evidence only supported use for patients sick enough to be hospitalized, while later, more robust studies have not even supported that. The EUA is still in effect however, which does allow physicians treating extremely ill COVID-19 patients in the hospital to weigh the evidence for themselves.
Why won’t the pharmacy fill these prescriptions?
At 7:36, Dr. Lozano begins the narrative that after her 1st or 2nd or 3rd prescription for hydroxychloroquine, the pharmacist called her to ask for a diagnosis. Dr. Lozano presents this as though it were a conspiracy or scandal, the pharmacist trying to breach patient confidentiality laws. In reality this is very common; knowing the diagnosis is important for the pharmacist for a number of reasons, including counseling the patient appropriately, ensuring that look-alike/sound-alike medicines have not been prescribed on accident (this does happen; I have done it and a smart pharmacist caught the error before the prescription was filled). In fact it is required with certain controlled medications. Your pharmacist is considered to be involved in your care, and sharing your diagnoses with them is not a HIPPA violation if it helps them do their job. Moreover, regardless of Dr. Lozano’s jab that “your job is to put the pills in the bottle,” pharmacists literally go to school for years to study medications; they already know your diagnosis from the medicine alone 99% of the time. No pharmacist is saying, “huh, Mr. Johnson is being prescribed Metformin. I wonder what that could be for?” It’s a diabetes medicine; they know you have diabetes. And that’s fine, because they also abide by patient confidentiality laws and aren’t going to go out and tell people about your diabetes any more than your doctor or nurse would.
With hydroxychloroquine specifically, the pharmacist was likely asking Dr. Lozano for a diagnosis because of the AMA/APhA/ASHP joint statement above, which includes this specific phrasing:
Or maybe it was because of this rule from the Texas State Board of Pharmacy:
So the pharmacist in this scenario was simply following not only the rules of his state governing board but also the consensus advice of the national organizations that represent his profession. Dr. Lozano states that she got around this by eventually finding a pharmacy that would fill the prescription, and by giving them a diagnosis of hypertension or diabetes instead of COVID-19 (it is unclear from her presentation whether these patients in fact have those diagnoses; presumably not, since her whole point is that she is unwilling to share their medical information with the pharmacy). So this requires us to ask the question; are these rules good? Is it reasonable to tell pharmacists that they shouldn’t or can’t fill prescriptions for this medication unless it is for Lupus, Rheumatoid Arthritis, or Malaria? In other words, should this decision really be up to the individual doctor?
In general, physicians tend to be wary of any rule or law that displaces medical decision making outside of the patient-doctor relationship. Dr. Lozano speaks to this around the 8-9 minute mark. The hope is that the years of careful education and training we receive should be sufficient to instill in us the weight of the responsibility we have to follow the evidence and to treat with a light touch in the absence of strong evidence. I believe it generally is. However, there are over a million physicians in the US alone, and oversight and accountability are necessary. As someone who works in the area of opioid dependence treatment, I strongly believe that top-down measures to curb the prescribing of opioids has helped many people avoid addiction and dependence. In the case of hydroxychloroquine, these decisions were made to prevent stockpiling and overprescribing of the medication that would create a shortage that hurt patients who needed it, including those with conditions such as Lupus, and early on, patients in the hospital who were sick enough to be prescribed it for COVID-19.
But it is possible to imagine scenarios where this medication could have been legitimately prescribed in an outpatient setting, at least early on before more data was available. One could imagine a confluence of circumstances where a patient met or nearly met hospitalization criteria, but could not be hospitalized for some reason; being the sole caregiver for a small child and needing to wait a few days for family to return, for instance, or living in a city where the hospitals were full and they didn’t quite meet criteria for hospitalization during the pandemic, even though they might have under normal circumstances. One could imagine a patient in the midst of a work-up for Lupus, whom their doctor was considering starting on hydroxychloroquine anyway, suddenly being diagnosed with a mild case of COVID-19. Would it be legitimate for this to shift the balance of risk and benefit and justify its use now instead of once the work-up is complete? These situations would be exceedingly rare, but they are possible, and it would indeed be frustrating to be a doctor or patient stuck between these realities and the Pharmacy Board’s rules and be unable to get the medication filled.
But is this the case with Dr. Lozano’s patients? Dr. Lozano gave an interview on Fox News where she shares more details from her experiences with the pharmacy. She states, “Yesterday I wrote 5 prescriptions for hydroxychloroquine… Today was horrible, I had 15 people who needed 15 prescriptions.” I have never been in Dr. Lozano’s clinic; I was not there on the day she gave the interview, and cannot vouch for either the COVID-19 status or the severity of illness of her patients. But the idea of one physician in a solo practiceseeing 20 patients in 2 days who have COVID-19, and are sick enough that they should have been hospitalized but weren’t, in a city that has only had 6,000 confirmed cases total, is extremely far-fetched. Rather, this paints the picture of a physician who has chosen to simply give the people what they want, and instead of following the evidence and carefully weighing risks and benefits on a case-by-case basis, chose to cultivate a reputation (and client base; she says she has patients driving in her to see her from Austin and San Antonio) by being the doctor who would prescribe the medicine that was suddenly being talked about all over social media after the president’s press conference. Any doctor who suspended their clinical judgement and prescribed hydroxychloroquine for every cough and fever patient who wanted it in March and April could have done likewise; and that is exactly the kind of prescribing practice that the Texas Pharmacy Board rules and the statement by the AMA were meant to protect against.
But what about Dr. Lozano’s experiences with the medicine? Doesn’t that prove it works?
Please listen to what Dr. Lozano says at 7:15.
“I have patients at Lozano Medical Clinic who are cured of this disease. I have patients that recovered within 48 hours. In fact, the illness that they had was more caused by the stress and the fear of the propaganda that’s being spewed on the news media than by the actual virus.”
Dr. Lozano has told us that she prescribed these patients hydroxychloroquine. She has told us she prescribed them azithromycin as well. She has told us that she gave them ‘a few antibiotic injections’ just for good measure. She states that the FDA can approve you-know-what because she has seen patients get better with this treatment. She now tells us she believes most of their symptoms were from stress.
I also have patients who are cured of the virus; their immune systems did that for them. That’s what usually happens with most viruses, and it happens all the same without potentially dangerous or potentially lethal combinations of unnecessary medications. The number of cases where symptoms are so severe that someone needs a high level of support is particularly high for this virus, which is why we are dealing with a pandemic; but they are still in the minority, and Dr. Lozano has offered zero evidence (and quite a lot of counter-evidence) that these patients would have needed hospitalization without the medications she prescribed.
As a physician, I have bettertools for treating stress and fear about the virus; compassion, active listening, empathy, and careful explanations of the medical realities they are facing. As far as I know, none of those can cause sudden cardiac death.
“I think when you do things that are incorrect, you need to be thrown under the bus.”
Dr. Ivette Lozano
At 10:12 Dr. Lozano throws Walgreens Pharmacy under the bus. She says that if you have a prescription for hydroxychloroquine, Walgreens will call and ask you to fill the prescription in their drive-through instead of at the counter inside. An immuomodulator, for patients who have autoimmune diseases. That is sometimes being used to treat a virus, in the middle of a pandemic caused by that virus. Surely anyone can see that this is a reasonable request?
10:40 “If you are taking a prescription for hydroxychloroquine, they will ask you to come in through their driveway. Well you know what: maybe eventually they’ll ask you to wear a yellow star on your shirt.”
Internet memes and Godwin’s Law aside, this is an absurd comparison. Every clinic I know of has taken steps to ensure that all their patients stay safe during this crisis, and for many that means seeing patients with risk factors for COVID-19 complications and patientswith symptoms of the virus outside to prevent transmission. For whichever indication this medication was prescribed, picking it up at the drive-through is a reasonable step to keep both you and others safe. Is this what Dr. Lozano’s audience considers “oppression”? Is this comparable to the Holocaust? I understand that many people are legitimately concerned over the balance between safety during a pandemic and preservation of individual rights, but is going through the drive-through at Walgreens really the Rubicon we dare not cross? To quote one Twitter user:
Dr. Lozano then says that she has encouraged all of her patients to get their prescriptions filled elsewhere, and that gives me the opportunity to share my first financial disclosure in several months of arguing against financially motivated medical misinformation; my father manages a CVS (in a different state than where Dr. Lozano and myself practice). And while that doesn’t actually constitute a financial conflict of interest, on some emotional level I’m ok with Dr. Lozano calling out the competition here, the same way I didn’t like K-Mart growing up when dad was managing Wal-Mart stores. Call it tribalism I guess. In practice, the only time I care which pharmacy a patient chooses to use is when I know they will get a more affordable price somewhere else, and that’s when we talk through their pharmacy options more intentionally.
10:57 HIV vs. COVID-19
Dr. Lozano states that she trained in general surgery during a time when there was not a good test for HIV, so they took precautions with every single case and did not discriminate against people if they had the virus. It seems odd to compare a virus like HIV, which is very difficult to be infected by even through contact with blood, to SARS-CoV-2 which is spread by droplets and airborne transmission. Dr. Lozano is right that no patient should be discriminated against because of an illness, infectious or otherwise. She is also right that we should take precautions to keep ourselves, and others, from becoming infected. But this looks different for different type of infections, based on their infectivity, potential severity, and mode of transmission. Refusing to operate on an HIV positive patient because of their diagnosis would be discrimination; asking a patient with COVID-19 to use the drive-through during a pandemic- which we really all ought to be doing anyway if at all possible- is not.
11:22 “This virus is 98% treatable with no medication! For those 2% who are sick, the President of the United States has given us a phenomenal protocol.”
I’m going to pass over the fact that the president has apparently gone from being told about hydroxychloroquine by his advisors, to reading about it in his independent research, to now actually creating the treatment regimen himself. Fine.
The bigger issue with this sentence is the way that Dr. Lozano has distorted these numbers. Without getting into details about the percentage of patients who need hospitalization and the percentage that need to be in the ICU (these numbers have shifted and will continue to shift as we have better and better data and antibody testing, as physicians and epidemiologists have been saying since the start), we can accept and agree with Dr. Lozano’s point that only a relative few patients with COVID-19 will need intense and specific interventions; as we’ve already discussed most will get better on their own.
But it’s important to clarify two things. First, Dr. Lozano never mentions working in a hospital either in her youtube videos or on her website, only seeing patients in her clinic. I think it’s fair to assume she doesn’t see patients in an inpatient setting or treat critically ill patients in the ICU. This means that the small percentage of patients she mentions who are sick enough to need specific treatments and high-levels of care are not the patients she is interacting with.She has presented a narrative that says most patients get better on their own, so go get your hair cut and go shopping and if you happen to get very sick from COVID-19, go see her and she’ll prescribe you hydroxychloroquine. The reality is that the patients she is prescribing hydroxychloroquine for are the patients who would get better on their own; they are part of the “98%,” not the “2%.” They’ve already been evaluated by other doctors and were told, thankfully, that they didn’t need to be in the hospital. The patients who need the high level of care are actually in the ICU, those that made it there, and are fighting for their lives. Many of those who have had the worst cases and needed that level of care have in fact been treated with hydroxychloroquine, and many of those patients did die; this is where the more powerful and reliable data about it’s efficacy comes from, not from a small clinic that has drastically shifted the definition of ‘very sick’ because it never interacts with patients in the hospital and ICU.
And second, that small percentage of patients, for a virus that is this contagious, still represents an astronomical number of people. This is the same misrepresentation that Dr. Erickson spends the majority of his time on during his interview; the idea that if most people get better it means the virus isn’t very dangerous. Early mortality numbers based only on antigen testing have been in the society-ending range of 4%-12%, but we have known these numbers would come down once asymptomatic or minimally symptomatic cases could be accounted for. If this virus has ‘only’ a 1% case fatality rate, it still has the potential to overwhelm our healthcare infrastructures and kill millions without mitigation strategies. The danger is a product of the per-case risk multiplied by the infectivity, and this virus is both very deadly compared to something like the flu, which is scary enough, and also extremely infectious. A non-dangerous virus could not do to New York and Italy what COVID-19 has done.
“It is not dangerous to go to a restaurant, to go get your hair done, to go shopping.”
Well, it might be actually. I realize things are open now. This virus is very dangerous and unfortunately we do nothave a “phenomenal treatment protocol” that renders it harmless. Please make safe decisions for yourself, your loved ones, and your community.
I know this seems like a strange place to add my final thoughts (one might have expected them somewhere near… the end), but I want to honor the long tradition of TL;DR that has come before me. PlanDemic has been a fairly unique experience among COVID-19 misinformation videos so far. The production quality is much higher and the narrative, tied to the experiences (questionable though their veracity may be) of an individual scientist, is gripping. The story telling here is far, far better than any of the webcam style videos we have looked at so far, or even the interviews of Dr. Erickson or Dr. Ayyadurai. It’s actually hard to know how to categorize this video; is it an anti-Medicine conspiracy video capitalizing on COVID-19 fears and controversies, or is it a COVID-19 medical misinformation video set in a conspiracy theory narrative? Probably both, but I lean toward the former because while the conspiracy theory is well established and consistent, a brief version of the story Dr. Mikovits has been giving as her own interpretation of the events of her arrest and discreditation for years, the actual arguments surrounding the COVID-19 pandemic are piecemeal and self-contradictory, pulling from any and all vogue COVID-19 misinformation sources rather than forming any new or unified thesis. Still, given the popularity of this video, I will not be surprised if we begin to see more and more of these high production quality misinformation/conspiracy theory pieces; it seems to be an effective amalgamation.
I hope my reflections below prove helpful. My hope is that even if you do not have time to read this entire post (and I can’t blame you there; I don’t have time to read it either), you will be able to navigate to the analyses of one or two of the points from the video that you have particular questions about. If I don’t cover the points you are particularly interested in, feel free to comment below; or better yet, keep digging- I’m sure someone else has done a more thorough debunking on that point than I would have anyway. Thank you to those who have found this analysis relevant enough to share with friends and loved ones who are convinced by or sympathetic to the PlanDemic film; I hope that this information, combined with their affection and trust for you, is enough to open their eyes to the falsehoods being shared so widely, and to convince them to continue exercising caution against this terrible virus.
The link to the video that I originally shared is dead. It is still easy enough to find if you really want to watch it.
First Impression: The production quality here is going to be awesome. (00:04)
Learn about your sources before watching, and then watch critically. (00:10)
This is just good general advice; we trust far too much to our gut feelings (read: confirmation bias) when trying to decide on the veracity of new information. When I wrote about navigating medical misinformation during the pandemic, the first piece of advice I gave was to know your source. I would never argue that arguments can be discounted because of the source; but knowing something about the source is incredibly useful when engaging internally with the arguments, especially when choosing what degree of scrutiny to apply to them. This is especially true with a video like this one. The excellent production quality, the artistic filming and intentional choice of background music, the cinematography and editing, all of it is designed to be emotive and to render the content convincing. That’s not a bad thing; they want you to believe their message, presumably because they strongly believe it themselves. But when all of these features have the net effect of lending credibility to the speakers in the video, we may find ourselves attributing to them a certain expertise or background that may or may not fit. Knowing where they are coming from, who they are, and what they stand for before the emotive music begins gives you some context for weighing their claims outside of how those claims make you feel, or how much you would like to believe them.
By the way, this is the same advice I would give to someone visiting a church for the first time; don’t rely on your gut feeling as a guide to truth; emotive music and a well crafted stage presence can be incredibly convincing.
With that in mind, here are a few links to the main people involved in the video:
Dr. Judy Mikovits is a former researcher who holds a PhD in Biochemistry and Molecular Biology from George Washington University. She published a since-retracted study in Science in 2009 that eventually lead to the legal action she discusses in the video. You can read more about her on her wikipedia page or on the blog Retraction Watch, if it is ever back up again (I believe the viral video has crashed the site multiple times). Since then she is mainly known as a frequent speaker at anti-vaccine events.
Mikki Willis is founder of Elevate, the production company that released the documentary. Their prior work tends to be focused on spiritual energy and positive vibrations (they have a short video talking about restoring your frequency to protect against COVID-19), but this seems to be their first foray into medical misinformation viral videos. You can check out his facebook page here. Before this I believe their biggest documentary was Neurons to Nirvana: Understanding Psychedelic Medicines. Also, as someone who has been interested in televangelists and pseudo-christian faith healers for years, he strikes me as the non-religious, spiritualist version of the young, good looking charismatic faith leader.
The Minions of Big Pharma (O0:38)
This is my first red flag in the video. “For exposing their deadly secrets, the Minions of Big Pharma waged war on Dr. Mikovits, destroying her good name, career, and personal life.” Now, “Minions of Big Pharma” may mean a lot of things; he might be referring to actual lawyers who work for pharmaceutical companies, or to all pharmaceutical employees (although it’s hard to see how drug reps could ruin her personal life), or to some other group altogether. But in the alternative health world this typically refers to doctors and scientists (nurses are generally excluded because as a society we actually like them, so it’s dangerous to the alt-health narrative to loop them in on conspiracy theories)(oh, and happy Nurses Week to my brilliant and beautiful wife!).
Now, I can’t comment much on Scientists working in the lab, since that hasn’t been a major part of my life, but I pretty strongly suspect that they have little to no interest in ruining anyone’s career (and if stereotypes are anything to go off of the only personal lives they are ruining are their own! Bazinga!). I know scientists who have worked for Universities and for major corporations and their main interest has been, unsurprisingly, Science. They love talking about their experiments and research, and their ideas about what might happened next with their project. Remember that these are not nameless and faceless people doing experiments in some hidden lab; these are often the sciency kids that you went to high school with who genuinely loved experiment day in Chemistry class and who were probably reading Lord of the Rings before it was cool. And it’s these science nerds, according to this video, that have now all been recruited into a world wide conspiracy. Tony Fauci calls up one of them and says, ‘we need to discredit a virologist because we don’t like her conclusions about retroviruses; publish a fake study that says she’s wrong.’ It’s really, really far fetched. In fact, if you want evidence of the standards of veracity that scientists generally hold each other’s research to, look no further than Dr. Mikovits’s retracted paper in Science, which was retracted not because she was rocking some boat or bucking some system, but because the methodology was flawed and the results were not reproducible. If you’ve forgotten everything else about those Science Fair geeks from high school, remember this; welovedproving people wrong. The peer review process capitalizes on that, and the conspiracy that there’s a top-down cabal determining what gets published and what doesn’t ignores that one overarching character flaw.
What I can tell you, with no shadow of a doubt, is that your doctor doesn’t work for Big Pharma. In fact, the relationship between your average Physician and the drug reps they interact with range from the politely tolerant to the openly antagonistic.
And this is the case for any part of the medical industry that is primarily profit driven, whether it’s the pharmaceutical companies, fly-by-night medical supply companies, pharmacies, or the insurance companies. Because Physicians are not primarily profit driven; we are driven by a desire to help people. We are driven by a desire to help people so much that it is dangerously cliche to even say so on a medical school admissions essay. We’ve taken on hundreds of thousands of dollars in debt, sacrificed our 20’s and 30’s, and worked thousands of hours of unpaid overtime in order to learn the science and the clinical skills that we need in order to do the grueling work of helping people heal physically, emotionally, and psychologically, and there are just much, much easier ways to make money.
So that creates conflict. Conflict ranging from an annoyed ‘I don’t think that’s accurate’ to a pushy drug-rep overselling the latest product, to absolute rage when the price of a life-saving medication skyrockets for artificial reasons and my patients suddenly have to go without. But while we generally regard for-profit pharmaceutical and insurance companies to be side effects of a deeply broken healthcare system, they are still fixtures that we have to work with; and I guess that looks a lot like collusion to the outside world. Once you’ve bought into the myth that those with the most money universally control the people they interact with and endure no dissent, it’s easy to see conspiracies everywhere; of course the scientists are told what results to report, look who signs the checks. Of course the doctors prescribe what they’re told, their education is controlled by big pharma.
But might I submit that maybe ancient, altruistic, and (let’s face it) fairly egotistical professions don’t just roll over quite so easily? That maybe high standards of truth telling and care for the wellness and suffering of human beings are still the honored core of both the clinical and research branches of Medicine? In fact, I don’t think it’s a stretch to say that, to whatever degree drug or insurance companies really have wanted something like autonomous control over healthcare, it has largely been conscientious Physicians who have fought them.
But you don’t get to see those types of interactions that often at your doctors office, and this leads to a lot of pretty demoralizing misunderstandings; for instance when a patient’s medication should be $5 and they end up paying $50 at their pharmacy and think that I prescribed a more expensive medication because I’m getting a cut (this is why I now say to each patient at the end of each visit where I’ve prescribed a medication, “if you get to the pharmacy and any of your medicines are more expensive than you expected, please don’t buy it yet and give us a call instead”). It also means that when it comes to profits being put above people, we’ve probably just about seen it all, and fought against it all. So when even we have to say, yeah this looks like some pretty crazy conspiracy theory stuff, you need to understand it’s coming not from “Big Pharma’s” willing subordinates, but some of it’s most diligent and ferocious watchdogs.
“The plague of corruption that places all human life in danger.” (00:54)
I think the narrator is just waxing eloquent here, setting us up to understand that the medical field is the real plague or something like that (and if so it’s a good bit of work), but I’ll at least give the video the credit of seeming to take COVID-19 very seriously during the first minute. If you turn this off after minute one, you will at least leave with the idea that 1. there is a plague, 2. human lives are in danger, and 3. it’s a big enough problem that the fate of nations hangs in the balance. That plus the excellent production quality may go a long way towards fighting some of the ‘less dangerous than the flu’ misinformation that is out there already. Way to go, Elevate!
Minute 1 to Minute 10
The bulk of the first 10 minutes of the documentary are spent on Dr. Mikovits’s personal history of maltreatment by the health industry/scientific community. I think people should be able to tell their stories from their perspectives, and I have no doubt that the demolition of her career has been a very difficult experience for her regardless of the circumstances that caused it. Still, it is important to remember that most stories have at least two sides that have to be considered, and other interpretations of those events are available widely on the internet. It’s a very dramatic story and someone other than me will need to dissect it. I will return to this section with a few observations once I have finished the analysis of the rest of the video, but for now my most immediate concerns are the statements related to COVID-19.
Update: Having finally finished this blog post 3 days later, I have had time to read through other articles and watch other videos debunking the claims of PlanDemic. Many do it much better than I can. A great many have focused specifically on the first 10 minutes of the video, and investigating the claims that Dr. Mikovits makes regarding her own history and the conspiracy against her; many have already been familiar with this history and her work in the anti-vaccine movement prior to PlanDemic. I will defer to them. Certainly I have no first hand knowledge of the events and no background in investigative journalism. If you are watching the video, there are 3 things I would point out in this section that I think should at least increase your level of suspicion that you are watching conspiracy theorist/misinformation propaganda. 1. When Dr. Mikovits is talking about her arrest (the video leaves you to assume it was a 5 year imprisonment; it was actually 5 days), they show presumably unrelated footage of SWAT teams and urban tanks in order to inspire fear. 2. The clear implication, towards the end of this section, is that Dr. Mikovits might be assassinated for doing this interview. The credulity people have towards this claim has been amazing, with so many comments along the lines of ‘this woman needs protection now’. Yet, is there any basis for believing that there has been or will be an attempt on her life? And for what? Sharing information about the COVID-19 pandemic that is almost entirely verifiably false? 3. Dr. Mikovits has a book out. I don’t think that this is her primary purpose in giving her interview, and my understanding is that she has been involved in trying to clear her name and garner support against the scientific establishment for years. But so far, financial motivations being tied to viral misinformation videos has been batting a thousand during this pandemic.
Is this an anti-vax video? (9:48)
Dr. Judy Mikovits: “And they will kill millions as they already have with their vaccines.”
Mikki Willis: “So I have to ask you, are you anti-vaccine?”
Dr. Judy Mikovits: “Oh absolutely not!”
‘But see, she’s not anti-vaccine! This is totally mainstream stuff, not anti-vax propaganda at all!’
Rest assured that many people in both alternative health and the anti-vaccine movement see the pandemic as an opportunity to anchor their products and agendas more firmly in the mainstream. While this is often for financial profit or accumulation of power and influence (as has been the case with every single misinformation purveyor we’ve addressed on the blog so far), I still believe that here are many honest people who earnestly believe in these ideas, and merely have their facts and narratives skewed concerning vaccines specifically and the medical field in general. I know and really like some of them. In fact, a lot of friends whom you might call ‘vaccine wary’, medically suspicious, or crunchy and oily (their words!) have been incredibly supportive of me personally and other healthcare workers during this pandemic. They have struck a balance they are personally comfortable with that allows questioning their Physicians and arriving at different conclusions (which is a good thing in general) and still recognizing a bedrock of reliable truth telling regarding danger, disease, and treatment. I think all of us are looking forward to the day when we can just get back to arguing about tea tree oil in your belly button again (or was it thieves?), but with a real crisis like COVID-19 there is no question that we are all on the same side.
The problem is that as a counter-culture, these movements have overall tended to have a very low threshold for whom to trust, assigning credibility and reliability to almost anyone who is comfortable using the same verbiage and demonizing modern medicine. This means that while many people have found a balance that remains very safe for their families, many others who begin as simply cautious of certain chemicals or treatments (as likely as not because their doctor didn’t/couldn’t take the time to explain it to them very well) become entrenched in increasing (and increasingly dangerous) depths of falsehood. For some, this video, with it’s emotive music and deep state conspiracy theory, will be their next step. The leaders of these movements know this and see dollar signs, potential converts, or both; and the pandemic is a golden opportunity for them because we are all looking for answers. I’ve seen the fallout from this on the individual level in my own experiences caring for adults and children, and on a larger scale with measles and pertussis outbreaks that were totally avoidable. My fear is that, with something as dangerous as COVID-19, the suffering that occurs for the people believing these conspiracies could be the worst and most widespread yet.
Just past the ten minute mark, we finally get into a discussion of COVID-19.
Do you think this virus came from a lab? (10:21)
Dr. Mikovits is making claims that come off as extremely authoritative, but which nobody actually knows the answers to. Labs that have sequenced the genome of SARS-CoV-2 have said it appears to be a naturally occurring virus strain, but the idea of zoonotic transmission from meat sold in an open air market in Wuhan has seemed extremely speculative from the beginning. BBC has a good article discussing the difficulties in sorting through the origins of the virus. As a Physician my main concern is with the viral syndrome that it causes, not where it came from; but the idea of it being involved in any way with a research lab is extremely appealing to conspiracy theorists that would like this to be a Dr. Evil style attempt to conquer mankind.
But look what Dr. Mikovits is actually saying here; she doesn’t think this is a bioterrorism weapon that was designed or engineered, but that doesn’t matter because “You can’t say naturally occurring if it came by way of a laboratory.” Um… Why not? A few moments later she says ‘studied in a laboratory’ like it’s damning evidence. But the thing is… laboratories are exactly where you study things. She’s done a fair bit of it herself in the past. I spent a Summer studying Passalidae Beetles in a laboratory and they are pretty naturally occurring.
What they are saying here, really, is that the origin of the virus doesn’t matter for their purposes; whether it had been engineered as a weapon, whether it was accidentally released from a lab, or whether it just happened to be transmitted from an animal that was being studied in a lab. What matters is the word “laboratory”, because with the degree of fear and paranoia about scientific processes already experienced by many of their target audience, combined with anxiety about the pandemic, that is enough to score points as one more piece of evidence of a global conspiracy.
Finally, at the end of this section Dr. Mikovits claims that SARS-CoV-2 must have undergone “accelerated viral evolution” because if it were naturally occurring, it would take 800 years to develop from SARS. First of all, that’s a pretty specific time frame without any further explanation, so I’m going to call ‘citation needed’ on this one. But the biggest problem with that claim is… Nobody thinks it evolved from SARS in the first place. There are a lot of Coronavirus species, and we don’t yet know (and may never know) the evolutionary history of this dangerous, novel virus. It is called ‘SARS-CoV-2’ because it is a Coronavirus (CoV) that causes Severe Acute Respiratory Syndrome (SARS), and it is the 2nd one identified that does this (because MERS is the Rodney Dangerfield of Coronaviruses; it gets no respect).
Ebola couldn’t infect humans until Dr. Mikovits taught it to in 1999. (12:04)
The first major known outbreaks of Ebola occurred in 1976, 23 years before Dr. Mikovits taught it how to infect humans. So this is pretty nonsensical. The CDC has a good article on the history of Ebola Virus, but I suppose if you have chosen to believe the claims in this video you will probably see this as propaganda? The conspiracy theorist world is a much more interesting world, when even fairly blandly written (though quite interesting, to me at least) and well hidden disease history pages on government websites are all deliberate and carefully crafted deceptions.
But if course, she’s not talking about Ebola virus here, not really; the implication of the video is that somebody had to teach the COVID-19 virus how to infect humans.Add this to the list of claims in the video that have zero empirical support, but that devotees will come away 100% believing.
The COVID-19 death toll is inflated (12:22)
The tabulating of deaths from COVID-19 has been written about time and again. I wrote about it here a month ago when these conspiracy theories about doctors faking death certificates and being told to call everything COVID-19 were already being circulated. It’s been debunked thoroughly and frequently, and our best guess is that the actual death toll has actually been underestimated. We’ll do a little more debunking here, yes, but honestly it’s getting a bit old.
But the first thing I want to point out is how this video, as a smorgasbord of COVID-19 conspiracy theories, ends up mixing it’s message and contradicting itself time and again. We just spent several minutes focusing on their belief that the virus was created in a lab, that it was intentionally taught to infect human cells, and that it is part of a government plan (I mean, that’s thename of the video, PlanDemic), and now we are talking about how it really isn’t that dangerous. This video would like to have its virus and eat it too; it wants the numbers to be inflated, but it also wants the deadly disease to be an evil plot. Now, you could come up with some scenario that fits both conspiracy theories; the virus was released by Scientists (the minions of Big Pharma) but wasn’t as deadly as they had hoped, so they have had Physicians (the other minions of Big Pharma) inflate the death numbers. Sure, if you add enough layers to your conspiracy theory you can account for apparently contradictory sub-plots; but you also have to involve more and more willing participants in the conspiracy, and at some point you have many millions of people colluding in order to… what? Get some people to take a vaccine? Credulity can only be stretched so far.
The other thing you need to recognize is that Dr. Mikovits is about to step firmly outside of her training and experience, which has nothing to do with clinical medicine. When she speaks about discerning the cause of death, the interaction of chronic diseases with acute infections, and the realities faced by doctors fighting this horrible virus, she is speaking entirely as a layperson.
COPD deaths are being counted as COVID-19 deaths?! (12:49)
I am sorry her husband has COPD. That really stinks.
COPD (Chronic Obstructive Pulmonary Disease) and Pulmonary Fibrosis are different types of lung damage (maybe her husband has both, which is absolutely possible)…
…and neither looks like SARS.
“But he has no evidence of infection”. Well, that’s a really wonderful thing; it’s also an important point on the natural history of COPD. Most COPD patients do not have thickened mucous, extreme shortness of breath, severe dyspnea, and prominent wheezing all the time. When those symptoms occur we call it a COPDAcute Exacerbation. And when you have an exacerbation, it absolutely is a sign of something acute happening, usually a viral or bacterial infection.
(13:10) No they absolutely wouldn’t. If he walked in with no evidence of infection, he shouldn’t be walking in at all; the ER is a dangerous place for him now more than ever. But if he comes in with acute worsening of his pulmonary symptoms, the worst COPD exacerbation he has had in his life, requiring high levels of oxygen and even intubation and ventilator support, with exposures to the COVID-19 virus or symptoms consistent with the disease in an endemic area, are you really saying thatpolitically motivated incredulity about the virus’s infectivity and lethality trumps the doctor’s diagnostic skills? The thing they have been working their entire lives to develop?
The Doctors are telling us the numbers are inflated. (13:15)
I know hundreds of doctors personally, maybe thousands, and have read or heard from even more. Some of them work in the front lines in places like New York that have been hit hardest (so far) by the pandemic. Throughout this crisis I have reconnected with classmates and friends I hadn’t talked to in years to touch base on how this whole thing is going for them, how they are holding up. None of us are being told to fudge numbers. Even if we were being told to, we wouldn’t. There are over a million doctors in the USA and I am convinced that almost every single one of them would blow the whistle and be on youtube tomorrow if the government was asking them to artificially inflate numbers or lie on death certs. This is ridiculous.
But more to the point, the guidance that has come from the CDC has actually been really reasonable. Even the images shown in the video, which are supposed to be some sort of damning evidence, are reasonable:
What this is saying is that if it walks like a duck and quacks like a duck, but the COVID-19 test is negative or not available, it’s still reasonable for a Physician to rely on their clinical judgement to determine the diagnosis. This is the opposite of a top-down mandate, and more to the point,it’s already how we practice medicine anyway. If you have a sore throat, fever, red and swollen tonsils, and your son had strep, I don’t test you for strep throat, I treat you for it; you have it,regardless of what the test says. And that test has a much higher degree of reliability than the SARS-CoV-2 antigen test. If you have symptoms of the flu, and it’s flu season, I only test if it would actually help me make a treatment decision, which is fairly rare; the sensitivity of the test is only 50% to 70%, which means that up to half the time you have the flu your test is going to be negative. It’s too early to know exactly what the sensitivity of the COVID-19 test is, but early reports said somewhere around 70%; so doctors very wisely chose not to defer their clinical decision making to a test result.
Finally, there’s the case the doctor in the video discusses around the 13:40 mark: the 86 year old patient who dies from pneumonia, who wasn’t tested for COVID–19, but her son later tested positive for the virus. The doctor asks, incredulously, whether it would be reasonable to list COVID-19as a possible cause of death?
Every practicing clinician: Um, yeah, it would. In fact, these are the exact people we know are most susceptible to the virus, and the ones we are working our butts off to protect. Most of my 86 year old patients treat me like a grandson; we are treating this virus like it can kill them because it can.
13:50: Dr. Erickson owns Urgent Care Centers in a low-prevalence country in California. He is not being pressured to write COVID-19 on anything, and if he’s writing death certificates with any degree of frequency that is a big, big problem. He would like this pandemic to be not that big of a deal just like the rest of us, only in his case, it’s at least partially because his Urgent Care business is suffering right now. (Update: He has also released a statement saying he has no association with the PlanDemic video).
“You don’t die with an infection, you die from an infection.” (14:38)
While this is not technically true (people die with infections all the time. You can get hit by a bus on the way back from your abscess drainage), I actually completely agree with Dr. Mikovits here. This is the inverse of the common saying for Prostate Cancer, “most people die with prostate cancer, not from prostate cancer.” It’s a common form of cancer that grows slowly and often near the end of life; most people with it will die from something else. Contrast this to COVID-19, which is an incredibly dangerous virus that has killed 75,000 people as of today in the US alone, and even if you don’t believe those numbers has overwhelmed healthcare infrastructures, exhausted doctors and nurses (and driven some to take their own lives), and decimated entire countries. This is a dangerous virus. It increases risk of blood clots, it seems to be causing strokes, it shuts down the lungs; the idea that people are suddenly dying in large numbers from these types of syndromes and their having the virus is just a coincidence is insane. You die from the virus; not with it.
The numbers have to match the real-life narratives, but by avoiding any discussion of the experiences of doctors, nurses, patients, and families that have been affected by the virus, the misinformation promoters hope to bypass your compassion and even your sense of rational self-preservation and deeply ingrain the idea that the virus isn’t dangerous with fake numbers and false dichotomies between acute infection and chronic disease. If they are successful, then you will be automatically suspicious of any images, narratives, or personal accounts you hear that paint a picture of a deadly virus causing real human suffering. The word ‘trauma actors’ is not far off. Don’t let them rob you of your empathy for their own personal gain.
Doctors are being incentivized to list COVID-19 (14:44)
Check-out this article from PolitiFact that covers this question in some detail. Yes, part of the CARES act was to provide a 20% stipend for treatment of COVID-19 cases. This is being done because hospitals that are hardest hit by the pandemic are also the ones that are going to have trouble staying afloat; they will be cancelling elective cases and other more profitable treatments for longer and focusing entirely on COVID-19, often in the midst of needing to pay nurses and doctors overtime, hire outside help, and wildly exceed their budgets for PPE and supplies. Now, we can talk about whether or not I think hospitals being for-profit is a good model in the first place (hint: I don’t), but the idea that a bipartisan government stimulus for hospitals in the hardest hit epicenters of the pandemic automatically equals corruption and conspiracy is awfully flimsy.
But more importantly, I want you to watch the way the video, with it’s excellent background music and high production standards, weaves this part of the narrative. Go back and watch the 15 seconds from 15:00 to 15:15 and notice the way that the words “you’ll get paid $13,000” and “if that COVID-19 patient goes on a ventilator you’ll get $39,000” are overlaid against medical professionals, in PPE, treating patients in the ICU. Look at all of these doctors just waiting to cash their $39,000 checks from medicare,the video is telling you. The reality is that decisions about diagnosis and decisions about treatment are made by Physicians, who are not paid $13,000 for a certain diagnosis or $39,000 for initiating life-saving treatment. Depending on the way their compensation agreement is structured, they may or may not see any of that additional money (I certainly won’t should we get hit hard here in Waco and I have to admit COVID-19 patients or intubate the critically ill).
Also listen to Mikki Willis’s statement right at the beginning of the segment; “I’ve spoken with doctorswho haveadmitted that theyarebeingincentivized…” This is the verbal equivalent of the above cinematography trick, and is the type of sentence you can utter with impunity because there are so many doctors it would be impossible to prove he hadn’t talked with doctors who said this. But notice how doctors are only a reliable source of truth telling if they are blowing the whistle on some big conspiracy, and not when they are saying, en masse, ‘this virus is dangerous. we are doing the best we can to take care of patients but please stay home. there’s no conspiracy here, just a really, really bad bug.”
The ventilators are what’s killing patients! (15:15)
I’d like you to understand that Dr. Mikovits, who is a PhD virologist and not a medical doctor, is here repeating what she has heard or read and is not speaking as an expert by any means. I’ve had a friend write to me extensively about how dangerous ventilators are. I’ve seen videos and articles and facebook posts saying “88% of people who go on ventilators die”, as though that were proof that ventilators were dangerous, instead of that the virus is dangerous. (here is an article working through those ventilator numbers, by the way). You see, we only intubate the sickest patients, so they already have the highest chance of dying. There’s a confounding variable, and it’s called severe respiratory distress.
Now, I do think there is a discussion to be had here in terms of the best use of our ventilators. The myth here seems to be, as best as I can understand it, that “ventilators” are a discrete treatment the way “ibuprofen” or “knee injections” are discrete treatments; either you do a knee injection or you don’t (ok that’s also not accurate), either you give ibuprofen or you don’t. But ventilators are incredibly complex tools and their use is not monolithic. Here is a very basic but extremely helpful (at least to someone like me who doesn’t use a ventilator on a daily basis) guide to vent strategies from some people I admire over at EmCrit. Did you read it? You got all of that? This is the tip of the iceberg. Even the clip that PlanDemic shows at 15:18 is an ER doctor from New York early in the course of the pandemic arguing for a different ventilator strategy, not against the use of ventilators. His name is Dr. Cameron Kyle-Sidell, and he goes on to say:
“Now, I don’t know the final answer to this disease. I do sense that we will have to use ventilators. We’ll have to use a great number of ventilators, and we need a great number of ventilators, but I sense that we can use them in a much safer way, in a much safer method.“
So they’ve shown this clip to make you think, doctors are using ventilators because they get paid more money, even though it kills people, but a few doctors like this one are speaking out against this corruption. The real narrative behind this clip is a lot more reasonable and a lot more hopeful, and it’s this: doctors are trying to fight this new virus with the best tools they have, and impassioned discussions and debates about how to use those tools well are already happening. I am a part of a number of Physician COVID-19 groups on facebook, and both there and in private conversations and discussions within my own clinic system, every aspect of when and how to use ventilators to support COVID-19 patients is being dissected and discussed. It’s a good thing that we know more than we did a month ago, and the more we can delay the spread of this virus, the more we will know when it finally hits your area.
But let me make one thing abundantly clear; this is not a choice between using a ventilator and making more money, and not using one so the patient can get better; that is a false narrative and, frankly, on the grossly cynical side even for the conspiracy theory people. When you intubate a severely hypoxic patient, having tried everything else you know of to keep them off the ventilator, your decision is to use a ventilator or watch them slowly die gasping for air. Unless you’ve been in that situation, your theories on doctors putting patients on ventilators because they were told to or are thinking about their next paycheck don’t carry much weight with me.
And let me just state, for the record, that if you suspect a doctor at your hospital is putting people on ventilators or doing any procedure in order to make more money, you should report that person right away. That’s what I did the one time in my education or career I thought I had seen it happen. And if you believe it’s happening on a large scale, that doctors all over the country are doing it, please start thinking now about what you will do when your child or loved one becomes terribly ill at some point in your life, because if you have that little faith in the good intentions and integrity and medical knowledge of doctors and nurses, I cannot imagine why you would evercome to a hospital (though I honestly hope you do, because I believe we’d have the best chance of helping them, even if you don’t right now).
What about Italy? (15:35)
I just want to say that as little as I’ve found in this video to agree with, I really respect even the willingness to address the parts of the Pandemic that simply can’t fit it into their narratives (ok, I’ve actually found nothing to agree with; but there is at least plenty I can’t comment on. For instance, I can’t say whether or not someone planted evidence in her house before she was arrested).
When the Bakersfield Doctors, misled by their shoddy statistics, concluded that the virus wasn’t at all dangerous, they simply hand-waved New York and Italy as ‘hotbeds’ and moved along; it didn’t fit their narrative and so they didn’t even make a show of trying to explain how a non-dangerous virus could cause such catastrophic damage. The narrative here is infinitely more interesting.
Reason #1 is good; Dr. Mikovits says that Italy “has an older population, and they are very sick with inflammatory disorders.” Now, I don’t have any data on whether Italy has a higher rate of autoimmune disease, which I believe is what she means by inflammatory disorders; but I think we can accept the idea that older populations with more chronic illnesses are going to be at higher risk for complications, including death, from COVID-19. That is very consistent with the data we have seen throughout the pandemic. I would also point out that Italy is not alone in having an older population; many US States have similar demographics. 22.8% of Italy’s population is older than 65; but so is 20.6% of Maine, 20.5% of Florida, and 19.9% of West Virginia. If Italy can experience a surge of cases bad enough to overwhelm their healthcare infrastructure, there is nothing to prevent it from happening here. And of course, age isn’t the only factor; it has happened in New York, and only 16.4% of their population is greater than 65 years old. But the point is, saying ‘Italy is old’ doesn’t explain how a non-dangerous virus can kill so many.
But at 15:47 she loses me. Her claim is that in 2019 Italy had a new, “untested” form of Flu vaccine, and that this explains Italy’s high COVID-19 burden. She says the vaccine was grown in a dog cell line, and that ‘dogs have lots of coronaviruses.’
So, does that even make sense? Well, someone will have to tell me whether the flu vaccine used in Italy last year was new in the sense of being designed or developed differently from flu vaccines used in prior years or in other countries (in another sense, the flu vaccine is new every year because epidemiologists have to decide which flu strains to include based on which are most likely to become endemic). By the way, Italy had a particularly light flu season; so if it was new it may be a really good vaccine. However, the mechanism she is describing isn’t logical. First of all, the flu vaccine they use in Italy includes only killed viruses; your body is exposed to the antigens and can mount an immune response, but the virus cannot ‘come to life’ and cause the flu (or any other ‘inflammatory reaction’ she is hinting at here). The antigens of the dead virus are picked up by circulating white blood cells and presented to the immune system, so that the next time the body sees the virus it has the ability to rapidly produce a robust antibody response, usually before a person is even symptomatic (it does not work by creating a magic forcefield around your body that flu germs bounce off of).
But the trick is preserving the dead flu proteins without eradicating them completely. The idea that Coronaviruses have somehow come from a cell line used to develop the vaccine, have survived the process of creating the vaccine (all of the ‘harsh chemicals and toxins’ we are always hearing about), and have tagged along and actually entered the person’s body through the flu shot is nonsensical. Even if that were true (it’s not), she gives no clear mechanism by which that would have literally anything to do with COVID-19. Remember, Coronaviruses are a big, big family of viruses, and exposure to one would at worst have nothing to do with infection by another, and at best give some degree of cross-reactive humoral immunity, which sadly does not seem to be the case for COVID-19. Really, ‘dogs have lots of coronaviruses’ is little more than word association.
But the title of this article is “The Paradoxes of PlanDemic”, and here is another one. Just 5 minutes ago Dr. Mikovits told us that the COVID-19 virus, SARS-CoV-2, was created in a lab in Wuhan China, and was accelerated and manipulated in bats. So what would a flu vaccine in Italy, created in a dog cell line, have to do with COVID-19? There isn’t even a theoretical mechanism here; just the hope that by saying flu vaccine and Coronavirus close enough together in the video, their viewers will believe that the 30,000 deaths in Italy are actually another crime of the scientific community, instead of a stark warning of how bad this pandemic can become.
At this time the video has been removed from YouTube, Facebook, and Vimeo, the three sources I had used to view it while writing this post. I have mixed feelings about this. I don’t believe in censorship in general, but I also worry about allowing verifiably false propaganda to deceive millions in the name of freedom of speech, and the real human suffering that could occur if these videos were spread unchecked. I am a Physician, and it’s probably more a question for a philosopher or at least a constitutional scholar.
That said, if you do have a source for the video, feel free to send it my way via the “contact” page. Otherwise, the rest of my comments will be given without any time-stamp or specific quotes, though I have viewed the video in it’s entirety prior to now.
Hydroxychloroquine is a miracle drug, which is why they won’t let us use it.
I remember back in March (oh those carefree days, where have they gone?) when an OB/GYN I know, a friend from undergrad, first shared the French study showing promising results in COVID-19 patients treated with hydroxychloroquine, an immunomodulator we use mainly for Lupus, and azithromycin, an antibiotic (but you already knew that because they give it to you every single time you go to an urgent care…). At the time the responses of the clinicians I know ranged from cautiously hopeful to very skeptical. Hydroxychloroquine and azithromycin are not anti-viral drugs, some argued, and the study was so small that the results shouldn’t change our practice. Others argued that both medicines have some theoretical anti-viral properties, so even though they are not anti-virals per se there is at least a reasonable mechanism of action in play. For azithromycin, this involves anti-viral effects on the epithelial cells of the lungs; for hydroxychloroquine, prevention of viral entry into the cytoplasm of host cells.
Since this wasn’t a large randomized double-blind placebo controlled trial, this small article coming from France hardly constituted a gold standard of treatment; but since the medications were fairly safe and somewhat promising, and since it is the middle of a global pandemic, many doctors and hospitals began to use one or both. There were even some promising, but ultimately anecdotal results. Locally we used hydroxychloroquine but not azithromycin, generally, because of the concern that the combination of both could cause prolonged QT syndrome (which can, you know, kill you). Here is the very measured guidance from a field guide a friend sent me:
As far as I know, each hospital and Physician had to weigh this evidence for themselves. The FDA did release an emergency approval for hydroxychloroquine for COVID-19, and at no point were doctors told we weren’t allowed to use it, unless this came from their own clinics, hospitals, or medical societies; certainly I’ve never heard of any of the ‘doctors being threatened if they use hydroxychloroquine’ that they mention in the video. Unfortunately, subsequent larger and more intentionally designed trials have not shown a benefit; not to fault the French trial, they were trying to save lives and were publishing the modest but promising results they had so far, not trying to empirically prove the efficacy of the medicine. Here is an article from the New England Journal of Medicine that explains this all in greater detail, and the rationale by which the authors chose to stop using the medicine to fight COVID-19.
So that’s the story of hydroxychloroquine, and it’s hard to imagine how anyone could think there was any conspiracy behind that pretty straightforward sequence of events. Really, that’s how these things are supposed to work; if the treatment is safe and cheap and seems to help, it’s reasonable to use it while you are waiting for more reliable data. If that data then shows that the benefit just really isn’t there, you stop using it. When the president touted the drug as being promising, it was with his usual bravado but to some degree reflected the hope many of us felt about it at the time; when Dr. Fauci advised caution and stated the evidence was anecdotal, he was right, and was saying exactly what your local Physician might say at that point if she had been reading up on it. I don’t know anything about the doc yelling in the clip they showed, but unless he was actually treating COVID-19 patients and had some really excellent anecdotal results, I really can’t understand the vehemence he felt about the medicine; it hasn’t been warranted at any point by the evidence.
But before we move on, there’s one more thing I wanted to mention (and here is where I feel most keenly the loss of the video itself), and it’s that the idea of anyone in the healthcare industry actually trying to block doctorsfrom using a medication because it is working is obscene in the highest degree. I’ve seen enough corporate espionage movies and read enough Spider-Man 2099 comics to have a healthy suspicion of the big pharmaceutical companies, but I really believe this is beyond even them. But if you wouldn’t put it past them, at least consider this; if the government or big pharma or whoever were really telling doctors they couldn’t use a medicine that the doctors knew was saving lives, how would the doctors react? Would they go along willingly, because their one and only interest is obeying their corporate masters? Would they shrug their shoulders and watch people die who they could have saved?
Would you see just that one angry doctor ranting on YouTube, or hundreds of thousands?
Wearing masks increases your risk of infection, reactivates your own COVID-19.
To me, this is the strangest claim in the entire video, and it’s hard to understand for a number of reasons. First, how in the world is asking people to wear masks a conspiracy? Many of the masks we give to patients even in our own clinic are homemade, so it can’t possibly be Big Mask trying to turn a profit. I know many people chafe under any sense of the government trying to control them; but does this actually count, asking us to wear masks in public, that we’ve either made ourselves or gotten for free at our doctor’s office, to keep ourselves and especially others from getting sick? I don’t like wearing masks much either (unless it’s for Comic-Con), but it always strikes me as a particularly troublesome part of our highly individualistic culture that we oppose on principle so much that we ought to do voluntarily the moment there is even a hint of it being mandatory, particularly acts of charity (financial and otherwise) toward our neighbors. Remember, you don’t wear a mask for yourself; you are wearing it to prevent transmission if you have SARS-CoV-2 and are asymptomatic, to keep from spreading it to others.
Of course, this demands the question of whether or not wearing these homemade masks actually is an act of charity; that is, if it really does protect our neighbors from the virus. And as easy as it would be to simply say, ‘yes, masks obviously decrease transmission of respiratory viruses by blocking droplets’, the reality is that in science, what feels right or makes sense intuitively isn’t always a reliable guide to what’s true (hence this blog). So the real answer is; yes, they probably help. LiveScience has a good summary of the most current info and recent studies. With promising but limited evidence we have to weigh the risks and benefits. Remember what we said about using hydroxychloroquine earlier; if a treatment is promising, cheap, and safe, it’s reasonable to use while waiting for more data, and the same is true about prevention strategies. In this case, while we may well get more data we will likely never have a definitive answer about the degree of benefit. What would it look like, exactly, to do a large double-blind placebo controlled trial of wearing masks?
But Dr. Webb,you said the masks are only a good idea if they are safe, and the video says they aren’t. There is a very strange claim in the video, The idea that wearing a mask is somehow dangerous. I’d be remiss if I didn’t mention that they are once again contradicting themselves, but this time in rapid fire sequence. They want at once for the masks to be bad because they keep viruses and bacteria out (they show the clip of Dr. Erickson talking about how touching your face and eyes is vital for your immune system, failing utterly to distinguish between a deadly pathogen and mere microbes), and for them to be badbecause they expose you to your own microbes. This is not only poor science, it’s also poor debating. To borrow from Scott Adams (Dilbert), it’s like saying Sorry, I never got the message to call you. And when I did return the call, you didn’t answer. One excuse is better than two.
But I think what’s really going on with this claim is two things; an appeal to the deep desire we all have for a sense of normalcy, and an exploitation of the sensationalization of wearing masks. The truth is that wearing masks isn’t new, and we do it all the time anyway. I wear a maskfrequentlyat work because it both protects my patients when I have a cough that might be infectious, and protects me from respiratory organisms. But you wear a mask too. You wear one when you have the flu and don’t want your kids to get sick; people ask me for them all the time when they are at the office. You wear them when you go snow skiing, or when you are around dust, or when you are painting or staining wood or doing projects with strong fumes, or at Halloween. I’ve never heard of anyone, health conspiracy theorist or otherwise, crying out that they were dangerous, that they reactivated your own viruses or starved your brain of oxygen. But now that it’s a matter of admitting how deadly and dangerous this virus can be for the people you are interacting with and following a reasonable recommendation from the government, all of the sudden they are part of a conspiracy, a symbol of oppression?
All of that said, there is one situation where wearing masks really is dangerous, and it’s when people treat them as though they alleviate the need for any other safety measures; as though it made them invincible from the virus. With only limited efficacy at protecting against respiratory viruses, masks are not the ultimate answer to COVID-19, and physical distancing, hand washing, and careful mitigation strategies are still vitally important. But most of us can remember to do those things while still wearing a mask.
Healing microbes in the Ocean.
I’m sorry, I’m just totally lost here guys. Maybe she means these?
COVID-19 Deaths from the day PlanDemic was released:
So the video has resurfaced (thank you to all who provided the links), and rather than any “DOCTORS CRUSH COVID-19 CONSPIRACY!” headline, it has been posted with the much more subdued (though still fairly inaccurate) “Doctors report from Front Lines.” The whole point of their video is that they really haven’t been at the front lines because the surge isn’t there yet; but since that is exactly where I find myself as well (albeit gratefully), maybe I shouldn’t put too fine a point on it.
A note on timing: Since the original video on YouTube was removed, I’ll be working off of the video on Facebook here, which is about 12 seconds ahead of the video used in part 1.
In the last post we went through the first 15 minutes or so of Dr. Erickson’s video, addressing the gross errors in his statistics methodology that leads him to the clearly erroneous conclusion that COVID-19 is not very dangerous. For state after state and country after country, he multiplies the total population by the results of non-random testing that is not representative of that population, to arrive at outrageous figures for prevalence (number of cases) of COVID-19. This mathematical trick shrinks the death rate, certainly, but it isn’t founded in reality; these are figures that can only exist in Dr. Erickson’s mind and on his calculator. He does this while ignoring the best data we have available that shows very high case fatality rates for known COVID-19 patients, framing that data as a good thing. “New York has a 92% Recovery Rate! If you get COVID, 92% of you will recover!” This is exactly the same as saying that COVID has an astronomically high 8% case fatality rate, but he has chosen to frame this as a good thing by flipping the statistic.
Now that the video is available again (for better or for worse), we will move on to the other arguments in the video.
9:16 “Is this significantly different than Influenza A and B?”
This is a question I have already addressed here, but frankly it’s absurd to still be comparing COVID-19 to influenza this late in the game. We are less than 2 months in from the first reports of deaths from COVID-19, and already it has killed as many people as the worst flu seasons we have experienced; and most places have not yet experienced a surge in cases. Our comparisons for COVID-19 are the bubonic plague and the Spanish Flu, not seasonal influenza; even in a very bad year like 2017-2018.
Comparisons to the flu do not match the reality of the people facing this virus as patients or healthcare workers, and can only be clung to by those who have not yet been affected by the pandemic. This is an argument from privilege, pure and simple. And yet, all of us in healthcare sincerely hope that as many people as possible will still go on unaffected; I sincerely hope Dr. Erickson never has to recant this silly argument because the deaths in his own community have made him do so.
But a few more lines on statistics won’t hurt the discussion.
9:24COVID-19 Vs. Flu in the USA.
USA – COVID-19
“Which gives us a 19.6 positive rate out of those who were tested (emphasis mine). If this is a typical extrapolation (his term for ignoring all sound statistics and epidemiology principles for arriving at accurate prevalence data)”… ‘That’s 64 million people with COVID-19.’
So to summarize his math for the USA:
Known COVID-19 cases in the USA: 802,590
Dr. Erickson’s number of COVID-19 Cases: 64,000,000
63,197,050 without a confirmed diagnosis.
Actual number of cases: Unknown, because we do not yet have large scale, random antibody testing; in other words, we cannot yet actually do the type of math that Dr. Erickson is only playing at, because we do not have the data.
By the way, this also means that of the imaginary 64 million people who have had COVID-19, 79 times more people had the virus and didn’t have symptoms, or didn’t meet testing criteria, than those who actually had a confirmed case. This is a big, big logical leap from the rallying cry of ‘we need more testing’ that we have all been saying for a month, and it should be another check for Dr. Erickson when deciding whether or not to trust his data. He has talked briefly about quarantining the sick only, but the implication that his data leads to is that only a very small number of cases will even have symptoms. It’s hard to say if this is simply another oversight on his part, or if he is deliberately playing into the ‘we all had this back in December’ myth that has already been popular.
10:06 Why not the data for 2018-2019 you ask? Or average over multiple years? Because 2017-2018 was the worst flu season we’ve had in decades, and did nearly overwhelm the healthcare system in many places. He is cherry-picking his data; deadliest flu season vs. artificially minimized COVID-19 deaths.
10:00 “50-60 million with the flu (compared to his 64 million for COVID-19). 43,545 deaths. Similar death rate.”
Estimates vary, but most commonly reported is closer to 60,000 deaths from flu that year (not sure where he got the 43k figure from). But how is this data derived? Well, what they didn’t do was multiply the ratio of tests that were positive by the total US population (his methodology); this method would give us over 180 million cases. No, they used actual statistical modeling (https://www.ncbi.nlm.nih.gov/pubmed/25738736). They also didn’t then divide the number of deaths by some crazy high number to get a low case fatality rate; instead they did much more complicated math to determine the excess attributable mortality. So already we are comparing apples to oranges, except that since his data is the product of his imagination, we are really comparing apples to… well, to some made up fruit.
Oh, and they didn’t do any of those calculations early in December before most places had even experienced their peak flu season, which is what attempts to ‘close the book’ on COVID-19 data right now amount to.
10:25 Again, he is talking about a flu season that lasts for 4-5 months, for which there is a vaccine (he will say this in a moment), and which has a much, much lower mortality rate. And we probably should be considering some of those things, to some extent, each flu season anyway.
10:55 Resisting the urge to dig on Urgent Care’s here. Testing everyone for flu is not sound clinical medicine. But that’s a different rant entirely.
13:47 Here he compares California to Sweden briefly. Again, do not trust anyoneto do statistics work for you if they are comparing regions without looking at population size. He is comparing the number of deaths in California (“with isolation; 1,220”) to the number of deaths in Sweden (“without isolation; 1,765”) and saying they are similar, with just a quick nod to their populations; “we have more people, but…”
Here’s how he should have phrased these numbers, if he really wanted to compare the impact to date of COVID-19 in these two regions:
California Population: 39.51 million
Number of Deaths: 1,220
Deaths per 100,000 People: 3 “with isolation”
Sweden Population: 10.23 million
Number of Deaths: 1,765
Deaths per 100,000 People: 17 “without isolation”
It isn’t fair to compare these two places in the first place, since a true surge hasn’t hit California yet (at least partially because of social distancing/mitigation measures), and because California and Sweden have very different healthcare structures and very different population vulnerabilities and demographics. But if we did a Dr. Erickson style extrapolation from Sweden to California, we would estimate 6,817 deaths so far in a California “without isolation”, 5.7 times higher than “with isolation.”
But again, these aren’t meaningful comparisons because statistics is a real field of mathematics and it doesn’t work that way. You can’t just take number of deaths from one place and multiply it by the population of another place and say ‘well this is the best data we have so we might as well trust it’, just like you can’t take data from very limited symptomatic testing and ‘extrapolate’ it to the entire population. The assumptions underlying the calculations are every bit as important as the calculations themselves, and so these particular ‘statistics’ I’ve just made up are probably only marginally more helpful than the ones Dr. Erickson made up.
14:00 Brief discussion of Sweden (1,765 deaths) and Norway (182 deaths) in Part 1 as well; the difference in how these nations have been affected by COVID-19 is only “statistically insignificant” (and not even then) when you invent tens of millions of phantom COVID cases to minimize the deaths, injury, and suffering of real life people.
14:58 Weird one to include, but ok.
15:14-16:47 Secondary effects of COVID-19
It’s pretty ridiculous that I’ve been trying to finish this overlong video analysis for 4 days now, writing between patients and during lunch, at the end of long days of clinic and pausing to read the Hobbit to my children, and have only made it to the 15 minute mark. But this is where I’ve been trying to get to, wading through all of the bad statistics and the misleading numerical comparisons, because it is this segment that I’ve been wanting to get to.
Because here, at least, I 100% agree with Dr. Erickson.
Doctors hate disease. We hate suffering. We hate abuse and neglect. We hate that people find themselves in dark places where there seems no way out. We probably hate it more than anyone except those experiencing them and the people who love them. The less wise among us take on far, far too much of that anguish in hopes of offloading a little of it from our patients; sometimes with tragic results. We took an oath to First Do No Harm and we take it pretty seriously. There’s a cultural myth that doctors like illness because without it we wouldn’t have jobs; which is a bit like saying that teachers like ignorance or soldiers love the enemy… although in the latter case, they really ought to, even if they still must fight them. Every doctor I’ve ever met would joyfully find a new line of work tomorrow (most of them are very talented) if they woke up to suddenly find disease, mental illness, physical pain, and all human suffering had suddenly ended forever (and some of us firmly believe that this is exactly what will happen).
In spite of everything, I believe this is probably true even of Dr. Erickson, and that when he is speaking of the suffering that will result from the necessary measures to fight COVID-19, he is speaking for the first time in this video as a Physician and not as an Entrepreneur. I think that’s why he’s had to dive so deeply into his false numbers in order to justify essentially ignoring COVID-19; because if he didn’t really convince himself that it wasn’t the threat that it so clearly is, he probably couldn’t bring himself to risk lives by making this video. At least, that is my sincere hope.
We are all concerned about the secondary effects he is talking about here. I wrote over a month ago, “All of us are afraid of a second spike in COVID-19 deaths if social distancing measures are discontinued too soon, but we are also concerned about a third spike; a spike of all-cause mortality and morbidity from the disruption this pandemic is causing to our normal modes of treating patients. That’s why we are working around the clock to figure out the best way to take care of the patients under our charge while at the same time preparing for and fighting the battle with COVID-19.”
I’ve written about it elsewhere, so I won’t go into details about all the things my clinic has done to work hard to address these very real threats. I work with some amazing people and they have been working their butts off. Since day one we have talked about what this would do to mental health in our community, about children trapped at home with abusive parents, about those with already tenuous chronic medical conditions or severe anxiety and depression, those with addiction, those with food insecurity, those with so-far silent conditions that need to be caught early.
Honestly, these are the things we worry about anyway. I worry about my mental health patients every time I take a vacation. I worry about patients with severe chronic illnesses not being able to get seen every time I make the difficult choice to cut back in clinic, in any way, because I’ve been drowning at my job since 3rd year of medical school. When I don’t have the mental bandwidth or the time to ask a more in depth question or allow a few more seconds of silence that gives the patient time to respond in a less guarded way, I worry what might have been missed. These are the realities of being a Physician in modern healthcare.
Which means that at whatever point doctors can in good conscience advocate for lifting the burden of social (physical) distancing and quarantine and sheltering-in-place off of our patients, friends, families, and selves, we will be the loudest and most persistent voices. If Dr. Erickson’s numbers were at all reputable, we would be thrilled; we would shout it from the rooftops. But they aren’t. And as someone who takes care of many of the patients in my city that our data tells us have the highest risk of complications and death from COVID-19, the only choice I can make is to work hard on my patients’ and community’s behalf to mitigate not only the very real risk of this one deadly virus, but also all of these secondary threats he is naming.
16:55 See discussion of the flu above (didn’t realize he was going to jump around so much). All I’ll add here is a reminder that the CDC is calculating the death rate as a comparison of deaths to estimated cases based on the best methodology available. If we used the Dr. Erickson method, the death rate for flu in 2017-2018, the worst flu season in decades, would be 0.03% instead of 0.13%. But again, it’s not a method any statistician would be tempted to use, not on a dare.
17:26 “The lethality of COVID-19 is much less.” There it is; don’t let anyone tell you that this doctor is just saying that COVID-19 is like the flu in some vague way. He is definitively telling you one is more dangerous than the other, and he’s got it exactly backwards.
17:28 Could someone explain to me how a ‘hotbed’ of a not-at-all-dangerous virus can overwhelm an entire city and kill thousands?
17:44 “I’m sick of following the science. I’m just going to ask it where it’s goin’, and hook up with it later.” -Mitch Hedberg if he were a doctor, probably.
18:00 I would like to know where Dr. Massihi taught immunology. Maybe they will fill in the gaps later, but at this point this could mean absolutely anything. I taught Kaplan MCAT and LSAT test prep courses after college and I was fairly bad at it I’m afraid; do I also get to claim to have taught immunology? What about logic and analytical reasoning?
We all have courses in microbiology, biochemistry, immunology, pathophysiology, virology, etc. It’s part of our curriculum from pre-med onward; what he is describing is the same education that all Physicians have. But the thing is, just because we’ve all had that training doesn’t make us experts; relative experts compared to the general public, sure, but there are people who have studied these systems a lot more. It certainly doesn’t mean we are each entitled to our own opinion about how the human body works, because medicine is a hard science. If he is going to make claims about the immune system, his authority as a doctor isn’t going to get him very far; the immune system is the authority on the way that it works, so we need to check his facts against it.
18:18 – 19:38 This is something that seems to crop up in almost every single medical misinformation video. I’ve written about it here, and here, and did an entirely overwrought Star Wars analogy about it here; and other people have written about it much better and in more detail than I have. It’s a common theme among alternative health “experts” who are spreading misinformation right now; don’t hide from the virus they say, your body needs it to build up the immune system! It plays into a lot of the cultural myths that Physicians are only interested in giving chemicals and harsh drugs, think all bacteria are bad, and don’t know anything about the body’s own immunity; ideas that are popular in alternative health spheres. So it’s pretty shocking to hear it from a doctor.
The major failure here is to distinguish between microbes and pathogens. Pathogens are microbes that can cause disease in humans, and some pathogens are so dangerous that either vaccination or avoidance are the best strategies to prevent the terrible, possibly life-long suffering and death that can result. Yet these misinformation purveyors want to pretend that when public health experts and epidemiologists recommend practical methods to decrease transmission of just such a deadly virus, they are actually saying that you can’t go outside, you should live in a sterile room, and your kids can’t play in the mud. Dr. Erickson wouldn’t tell you to touch your face and not wash your hands if you had been around Ebola. He wouldn’t tell you not to wash the surface of your kitchen counter if you had been cutting up raw chicken. He wouldn’t tell you that exposure to viruses is important to building a healthy immune system if you were about to pet a rabid dog.
But because his fake statistics have convinced us and especially himself that COVID-19 is about as dangerous as the common cold, he is willing to spend several minutes expounding the value of touching your face and eyes and not washing your hands so you can get that good IgG and IgM and have a healthy immune response… in the middle of the worst pandemic in a 100 years.
19:26 Just to be clear, you do NOT need SARS-CoV-2 to survive.
With that I am going to pause for the night. Thank you to all who have read these two very lengthy posts, despite my failed endeavor at choosing a format specifically intended to force me into some sort of brevity.
If this video continues to be widely circulated among friends and family in the coming days, I will return to finish the other half. I haven’t even met Dr. Massihi yet; maybe he’s a super reasonable guy who is going to give a balanced counterpoint to Dr. Erickson’s perspective? (Update: Nope.)
But my guess is that we are only hours away from the Next Big Thing in COVID-19 misinformation, and I’ll be forced to abandon this particular analysis at 19:26, just under halfway. If there is anything that particularly needs to be expounded on later in the video, I’ll quietly post it above; but feel free to leave a comment if there is a statement or section you would like me to address. Otherwise, I hope my perspective as a Physician has helped you to make sense of the dangerous errors my peers have fallen into in this video.
“Without education, we are in a horrible and deadly danger of taking educated people seriously.”
Yesterday a friend sent me the following video and asked two things; would I write about it, and would I try to make it short! The second skill is not really in my wheelhouse, and it is a very, very long video, clocking in at 52 minutes; I am currently writing a 2 part essay on a video that is less than 5 minutes long.
I’ve chosen the “live tweet” format (I don’t know what else to call it) in order to keep my comments brief and in-line, chronologically, with the video itself; I am sure I will have some additional closing remarks, however.
While most of what I try to address on this blog falls into the first two categories of ‘lies’ and ‘damned lies’, Dr. Erickson’s analysis belongs primarily to the final category. Dishonest statistics are extremely difficult to dispel because those who don’t have a background or training in interpreting them are apt to chalk up disagreements to a mere difference of opinion about what the numbers mean. They are often right. However, in this case Dr. Erickson is actually creating false statistics out of thin air, and then framing his arguments with these imaginary numbers.
(Note on time: with the original video removed from youtube, these time stamps are going to be a bit off. The facebook video above is about 12 seconds ahead of the original video; so 0:22 becomes 0:10, 0:27 becomes 0:15, etc. Sorry for the inconvenience.)
0:22 Kern County California.
0:27 This is my first yellow flag; “ER Physician/Entrepreneur perspective.” Most doctors wouldn’t describe themselves in that terminology even if they run their own practice, so I’m listening very carefully for what the “entrepreneur” angle is.
Over and over again with these misinformation videos, we have seen that the creating of false information has some direct link to attainment of money, power, or fame for the person in the video.
0:45 “If that still makes sense.” This is the question on every person’s mind, and rightfully so. For medical people, clinicians and nurses, it’s a definitive and resounding “yes,” so I’m interested to hear his perspective.
1:00 Already this video is different from most of what’s going around, because these guys are actual doctors.
1:34 Here we reach the “entrepreneur” piece; my understanding is that Dr. Erickson is an owner or partner of Accelerated Urgent Care, a group of 5 Urgent Care centers around Bakersfield CA.
Two things about this: First, we do need to recognize that while Urgent Care centers can and do provide services that help take the pressure off of over-utilized hospital emergency departments, they are NOT emergency rooms, and so unless Dr. Erickson is also working in a hospital context it is not quite accurate to treat him as a practicing ER Physician; he is likely ER trained, but not currently working in that context.
Second, Urgent Care centers are indeed entrepreneurial ventures; they are for profit, like so many fixtures of our broken healthcare system. During this entire video we are going to have to ask ourselves how the pandemic is affecting his business, and how that is implicitly affecting his understanding of the situation and statistics.
1:44 See above.
1:58 I don’t know what “furloughing patients” means, but otherwise this is the exact situation in Waco; we’ll get into this in more detail later because I think it’s an important topic.
One note for now; do not fall into the trap of thinking that “empty ICU’s” means that the pandemic is not real. Cancelled elective cases and alternative delivery of care is part of containment measures in areas where COVID-19 has not yet surged, like Waco or Kern County California. The worst is yet to come.
2:03 Make note of this. Everything else that is said in this video needs to be understood in the context that even Dr. Erickson recognizes that this virus can overwhelm healthcare infrastructures; it’s doing it in New York right now.
2:30-3:02 He’s absolutely right, in a way. As I’ve written before, every single clinic I know of is working hard to make sure that their patients with chronic medical and mental health needs are still receiving the best care possible under the circumstances.
But there is another side to ‘secondary effects’ of COVID-19 as it relates to chronic conditions, and it’s this; as deadly as this virus is for people with the very conditions he is listing (in other words, their fear or caution is not unfounded), an overwhelmed healthcare system is also dangerous even apart from the virus. When patients who have heart failure or diabetes, or depression, or any other medical or mental health condition cannot get care because the healthcare system is overwhelmed with a pandemic, that is no less dangerous than not getting seen for other reasons; and probably much more dangerous in many cases because at least with the ‘minimum capacity’ healthcare usage he is discussing they could still get timely treatment in a true emergency, which is not a guarantee when the local ER’s are overwhelmed. These are difficult decisions that every clinic, hospital, and system is weighing carefully; and the quality of that decision making depends on reliable COVID-19 data, as we will see shortly.
One more note; this absolutely is being talked about, and extensively. Don’t fall for the “why are the higher ups keeping quiet” argument about very complex medical systems and situations; these conversations are being had on every level and have been for months (I have yet another Zoom meeting this afternoon about this very issue).
3:17 I think this is a really misleading way to frame the amount of data we had 1-2 months ago, and at the beginning of our social/physical distancing measures. Cases began to rise outside of China in early to mid February, and We already had 100,000 confirmed cases worldwide by March 7th. It was officially declared a pandemic on March 11th. So those (not) early (enough) decisions to begin social (physical) distancing measures were made based on data, not in the absence of it.
3:33-3:50 This is a false equivalence, and actually rather silly. What would it look like to quarantine the healthy because of ‘normal’ infectious diseases? “Sorry Billy, no school today; somebody at your school has pink eye so everyone is staying home.” “We can’t go to Church today kids; the pastor’s daughter had Hand, Foot, and Mouth Disease.” Pretty ridiculous, right?
But our template for COVID-19 is not pink eye, or strep throat, or even the seasonal flu; it is the 1918 Spanish Flu pandemic, smallpox, and the freaking Black Death. He is acting as though he didn’t study these diseases and periods of history in pre-med and Medical School.
In a Pandemic, social (physical) distancing, what he is calling ‘quarantining the healthy’, absolutely saves lives. If you don’t believe me, read this article. Or go play the Plague, Inc flash game and try not to throw your phone across the room when Madagascar shuts down it’s seaports.
4:21 I didn’t realize what he was trying to say here right at first, but it’s worth pointing it out here instead of 10 minutes later when it finally hit me, since this is actually his main thesis throughout this video.
People tested: 5,213, Positive Cases: 340
Dr. Erickson: “That’s 6.5 percent of the population.”
Wait, no, it isn’t!
“Which would indicate that there’s a widespread viral infection.”
No, it doesn’t.
You see, this is where the statistical bungling really begins; he’s saying that since 6.5% of the people tested were positive for COVID-19, we can conclude that 6.5% of the entire population has it. But that’s an absolutely erroneous conclusion, because the testing wasn’t random. This testing was done, especially early on, primarily on patients who had symptoms of upper respiratory illness and fever, had known medical conditions that made them high risk of complications from COVID-19, and who had some degree of known exposure to the virus.
Do you remember how just a couple of weeks ago so many people were upset that they couldn’t be tested because the criteria for testing was so strict? The fact that only 6.5% of even these patients had positive tests shows that the virus is not yet widespread in Kern County California, just like it isn’t here in Waco, or in any city that hasn’t yet hit a surge in COVID-19 cases yet.
This data cannot be “extrapolated” to the general population to determine the prevalence of the virus because the testing, so far, has not been random or representative. His methodology sounds reasonable enough on the surface, but it is actually leading him to wildly inaccurate numbers and conclusions that are the exact opposite of the case.
“We think it’s kind of ubiquitous throughout California. We are going to go over the numbers a little bit to help you see how widespread COVID is.”
This should properly be understood as Dr. Erickson’s thesis for this video.
33,865 Positive for COVID-19.
“That means that 12% of Californias were positive for COVID”
Except it doesn’t,because you can’t get data on the number of cases in the state from non-random testing of symptomatic individuals with known exposures.
5:08 These projections were based on what would happen without social/physical distancing, shelter in place orders, and other mitigation strategies. The fact that it “hasn’t materialized” is evidence that mitigation is working. We have been saying since day 1 that as soon as these strategies started to show success, people would say they weren’t necessary.
5:20 You cannot extrapolate prevalence data from testing of symptomatic individuals. We will explore how you could get this data later on, but for now, each time he ‘extrapolates the data’ you need to realize that the number that results doesn’t actually mean anything.
5:32 “That equates to 4.7 million cases in the state of California.” (No epidemiologist believes this; this is a nonsense number.)
“We’ve had 1,327 (now 1,651) deaths in the State of California with a possible prevalence of 4.7 million.”
“That means you have a 0.03 chance of dying from COVID-19 in the State of California.”
Do you see what he’s done here? He’s multiplied the percentage of tested cases that were positive by the population of the entire stateand called that number, 4.7 million, “prevalence.” He’s then divided the number of deaths by that gigantic made up number in order to make the death rate seem incredibly small.
You are supposed to think, “wait, I heard something like a 3-4% death rate, but he’s saying it’s 0.03%. They’ve blown this whole thing out of proportion!” But the number he is deriving is incredibly small because the fake denominator he has come up with is gigantic; and that is going to be the case for any location regardless of whether they have yet been hit hard by COVID-19, because while he is multiplying the percent of positive tests by the entire population, the number of deaths stays the same. He is comparing known COVID-19 deaths not to known cases, but to a wildly inflated ‘guess’ at the number of cases that is not based on sound epidemiology statistics principles.
In fact, while he isn’t really calculating anything, what he’s closest to deriving by comparing number of deaths to population is what’s called the mortality rate, and since mostpeople don’t die in any given year, this number is always going to be small compared with the general population; any number of deaths looks small compared with 328 million people. This is the reason we talk about mortality and attributable mortality rates in terms of ‘per 100,000 people’, because most of us (myself included) can’t conceptualize the significance of very, very small numbers. If I told you that the mortality rate of heart disease is 0.122% and the mortality rate of cancer is 0.049%, that’s going to be much less helpful than the more typically reported figures of 165 deaths per 100,000 vs. 37 deaths per 100,000, respectively.
So, what he’s giving us is an erroneously calculated ‘death rate’ that is so impressively tiny it cannot be conceptualized and compared well, in place of the commonly discussed and oft debated case fatality rate, which is the chance of dying if you do get the virus.
6:10 “I also wanted to mention that 96% of people in California who get COVID recover.”
Here he has tipped his hat; this is the case fatality rate. You see, the opposite of ‘recovering’ is ‘not recovering’, i.e. dying. He’s sharing the actual case fatality rate, what laypeople call the death rate, but in a form that is unrecognizable.
This is a classic spin technique; flip the statistic so it suddenly sounds like a good thing. “96% is really high! Recovery is good! See, the good thing has a high number, so we are fine!” But if 96% recover it means that 4% die, and that number is astronomical for a case fatality rate, far closer to the Spanish Flu epidemic (2.5%) than to the seasonal flu; and this is just in an area where the healthcare system is otherwise slow due to COVID-19 concerns; in places where hospitals are overwhelmed, the death rate (case fatality rate) is much higher.
6:12 “With almost no significant continuing medical problems (sequelae)”
It is way, way too early to know what the long term sequelae from surviving this virus are going to be.
6:28 “This is our own data, this isn’t data filtered through someone.”
Like, for instance, an epidemiologist who could help make sense of it for you? Sorry, I’m getting snarky again.
6:42 This is exactly backwards; the more the prevalence data goes up, the more positive tests you will get; but because it’s the real prevalence and not the erroneous prevalence he has calculated, that increasing prevalence will be accompanied by increased hospitalizations and increased deaths.
6:47 He’s just admitted to the calculation error I was talking about earlier. Incredible.
6:53“Millions of cases, small amount of death”.
He says this over and over again; it may as well be the title of the video. Except it isn’t true; there isn’t any evidence that there are millions and millions of cases in California (41,000 confirmed at this point), and the number of deaths is anything but small. By the end of this week we will likely have passed the deaths from the worst flu season I’ve ever experienced, 2017-2018 (62,000 deaths), and epidemiologists believe we are underestimating the number of deaths from COVID-19. Moreover, this hasn’t peaked yet in most areas of the country; if we stop mitigation efforts, this could blow anything in our lifetimes right out of the water.
7:05–8:56“So I want to look at New York State.”
25,272 Positive Cases
19,410 Deaths (not sure where he got this number from)
“That’s 39% of New Yorkers tested positive for COVID-19”
At this point one of the reporters clarifies that it is not 39% of New Yorkers, but only 39% of people who were tested in New York State, and how if it were 39% of New York’s population that would be nearly 10 million cases of COVID-19 in that state alone. This is an incredibly important distinction. Dr. Erickson acknowledge this but fails to understand the implication; he is still insisting that you can “extrapolate” data from the testing that has been done.
An explanation of why we can’t extrapolate the information he thinks we can, and how we could get that data.
This data can’t be used for the purposes he is trying to use them for, for at least three very compelling reasons. First, it’s the wrong testing strategy. He keeps saying you can extrapolate the test data we have to the general population, but the people who were tested do not represent the general population. They have self selected due to exposure or illness and, especially early on, had to meet very strict criteria (or be an NBA player or celebrity) to even get tested in the first place because of the shortage of tests; these tests were done on the people who were already the most likely people to have COVID-19, and so their percentage of positive tests (39% in New York, 12% in California per Dr. Erickson) is going to be far higher than any other group. Even accounting for asymptomatic carriers, there is no reason to believe that asymptomatic people would have the virus at anywhere near the rate of people who have symptoms of the virus. This is… pretty common sense stuff, actually. For testing to be used to extrapolate to large numbers that give us population level data, it has to be random, and this is the opposite of random. So it’s the wrong strategy for the conclusions he is drawing.
But even if it were random, it simply isn’t the right sort of test for that. The current tests detect COVID-19 (SARS-CoV-2) antigen; circulating proteins specific to the virus; it is detecting the virus itself. It can do this before the patient is symptomatic if the virus is replicating inside them, but not once the virus has been eradicated from the body. Because of this, it’s actually the wrong test for the job; a person can test negative once they have recovered, so they would be miscategorized as a ‘negative’ test even though they had already had the virus. At best, a sufficiently large number of (random) tests done on the same day could give you a snapshot of how many people have the virus at any given time; this is called point prevalence. If this were at all possible, it would indeed be helpful for knowing the current risk of being exposed to the virus (though it would change quickly and require serial rounds of testing). But you can’t use it to determine a death rate; for that we need period prevalence, the total number of cases throughout the time period of the pandemic, and for that we need to know who has had the virus, not just who has it now. So, it’s the wrong test.
But it’s also the wrong time. If we want to know the final, true case fatality rate for COVID-19, which we all expect to end up being very high but much, much lower than the astronomical numbers we are seeing now, we are going to need that period prevalence for the entire period of time of the Pandemic. Even if Dr. Erickson’s calculations were correct up till now (and they are so, so not), it would still be the wrong time to rely on them because many of the regions he is discussing, including his home state of California, have not yet hit their surge. We don’t know what the death rate in California will be because the virus hasn’t come and gone yet; their healthcare system, doctors, and nurses are yet to be tried. It is the same in Waco; we are still in the long calm before the storm, hoping that something will give (a vaccine, a brilliant epidemiological strategy, a radical new treatment being discovered, seasonal decrease in transmission, etc) and we won’t have a surge at all.
So, what would an ideal testing strategy look like if we really wanted good quality case fatality data? It would use antibody testing (which tells us if the person has ever been exposed and had an immune response to the virus, not just if they have it right now), would be random, and would be done after or at least at the tale end of the pandemic. This would take into account asymptomatic and minimally symptomatic cases, and people who had symptoms but never got tested at the time. With a sufficient number of tests it could be used to extrapolate data for the entire population with a good degree of reliability. He’s probably right that we won’t ever do testing quite like that; but since there are potentially lots of other uses for antibody testing, and some of it involves testing people who aren’t actively ill, it is likely that we will get data that can at least be legitimately used to derive some idea of prevalence and true case fatality rate.
While we are discussing New York and possible testing strategies, it is important to note that there is some preliminary data about the actual prevalence coming out based on the antibody testing we discussed earlier, and the news is indeed hopeful; but even the most optimistic numbers so far only get the case fatality rate down to about 0.5% in New York, when you include asymptomatic carriers, assuming the sample is representative; 5 times higher than the number Dr. Erickson has landed on, and still incredibly dangerous. This is a number most of my colleagues would believe sooner than something apocalyptic like the 8-12% in overwhelmed healthcare systems across the globe, and Physicians and Epidemiologists have anticipated and saidfrom the beginning that these numbers would drop significantly once broad-based testing and antibody testing were available. But unlike Dr. Erickson, most doctors I know are not comfortable making that kind of stuff up and would prefer to wait for data that actually has a logical connection to the questions we are asking.
But even as more random antibody testing is done and death rates for COVID-19 hopefully trend down away from the utterly incomprehensible numbers they are at now, please remember; it isn’t just the case fatality rate that makes a disease dangerous, it’s also the degree of infectivity. Even if COVID-19 settles out to be less deadly per case than the bubonic plague or ebola or the Spanish Flu Pandemic of 1918, it can still kill incredible numbers of people if it makes up the difference by being highly contagious… Unless our mitigation strategies can prevent it from spreading.
8:12 Reporter: “Those models were based off if we did no social distancing.”
Dr. Erickson hand waves this off, but it’s an important point for understanding the timeline of this pandemic and understanding that those models are still a real possibility if we stop mitigation efforts.
It’s also an important opportunity for demonstrating some intellectual integrity, since the reporter is correct that those models were for scenarios where social distancing wasn’t followed, and Dr. Erickson has been dismissing them as ‘wildly inaccurate’. Sadly he fails to rise to the occasion and acknowledge this.
8:54 “We extrapolate out and use the data we have, because it’s the most accurate we have, versus the predictive models that have been nowhere in the ballpark.”“
This is a blatant false dichotomy. The predictive models were done to show the range of possibilities of the impending danger if no action was taken; the antigen testing strategy to identify and isolate cases. Neither can be used to establish actual prevalence, but he wants us to think we have to accept his calculations, based on erroneous assumptions, because it’s the only option.
8:59 “So how many deaths do they have? 19,410, out of 19 million people. Which is a 0.1% chance of dying from COVID in the state of New York. And they have a 92% recovery rate! (Edit: That’s an incredibly high known case fatality rate of 8%!) Millions of cases, small amount of death. Millions of cases, small amount of death.“
I want to be as generous as possible here. I really believe that this could be me, were the circumstances different, going on youtube and sharing these false statistics. Yes, Dr. Erickson has financial interests at stake here, but so far I’ve been inclined to think that he really believes his numbers. When you are pouring over data like this for hours or days and you think you’ve hit on some vital statistic that nobody else is picking up on, and it confirms what you already really, really want to believe, it can be so easy to get tunnel vision and not check your math against the backdrop of reality.
But New York should have been the “Aha!” moment for him; the point where he sees the house of cards he’s built collapse so he can start over from scratch with all of his equations. 19,000 deaths; 19,000 deaths in one state, in one month. Overwhelmed hospitals, too few ventilators, nurses and doctors collapsing at work. These stories from the front lines should be enough to make him question the conclusions he is drawing.
If you are calculating a pediatric dose of antibiotics and arrive at instructions that tell the parents to give 28 teaspoons three times per day, you’ve made a mistake somewhere; it doesn’t matter if your math was perfect, something must have gone wrong because those numbers don’t mesh with reality. If you are trying to figure out how long it will take you to drive from San Antonio to Waco and google maps tells you it’s 22 hours, something went wrong; it doesn’t matter how good their calculations and traffic algorithms are if the app thought you meant Waco, Montana instead of Waco, Texas. And if you are trying to derive real-life mortality data from numbers available on google and discover that a virus that is killing tens of thousands in a short amount of time, overwhelming hospital systems, and leaving your colleagues in New York with post traumatic stress disorder is actually not that dangerous, you’ve probably made some flawed assumptions before you even fired up your calculator. Your mathematical conclusions have to line up with reality, and hisdon’t.
He has concluded that COVID-19 is no worse than the flu, which in any given year will kill between 10,000 and 60,000 people nation-wide over 3-5 months. But the deaths of 19,000 human beings, with friends and families, who wouldn’t have ‘died anyway’ at this time, many while their doctors and nurses looked on helplessly because they had not the time or lifesaving equipment to intervene, in one state in one month, should be a wake-up call even for him.
9:48 “We’ve tested 4 million people. Germany is at 2.” The population of the US is 330 million and the population of Germany is 83 million; their tests per capita is double ours. He hand waves this with ‘sure I realize their populations are lower, but…’ Don’t trust anyone with your statistical analysis who waves away the single most important statistical number for comparing countries, their respective populations.
And at this point, mercifully, the video has been removed from Youtube for spreading verifiably false information. This is a double-edged sword, because it inevitably means that copies of it will be spread elsewhere with the heading “BANNED FROM YOUTUBE!”, and even more people will click, watch, and be deceived (or more likely, further entrench the false narratives they have already chosen to believe before watching). If someone does have links to the video when it’s up again, please send it my way so I can finish the other (checks notes) 45 minutes of the video.
But some sanctions cannot be waived away by your being popular with conspiracy theorists. The American College of Emergency Physicians and the American Academy of Emergency Medicine today released a joint statement condemning the irresponsible and flawed information in the video. And while the parts that we have covered so far have been mainly bad statistical analysis disconnected from reality, there are statements made by these doctors later (which I cannot now quote verbatim) that much more flagrantly disregard the oath they took in medical school. I honestly hope these are played back for them the next time they are set to renew their board certifications, and indeed their medical licenses.
With the video down, I’ll have to conclude here for now, and considering the number of charts I need to close for clinic, I can’t thank YouTube enough for taking down the video when they did.
Over the next 10 minutes or so, Dr. Erickson applies his same flawed methodology to other countries, multiplying their positive test rate by their total population to come up with his fake prevalence numbers, and then dividing the number of deaths by that to show how not dangerous the virus actually is. “Millions of cases, very small deaths.” If the video ever comes back, you can watch him do it time and time again, as a tutorial of sorts, so that you too can enjoy creating your own fake statistics at home.
And this leads him to conclusions which, while obvious from his erroneous numbers, defy both our reason and the experience of our fellow human beings. He concludes, remarkably, that the COVID-19 virus has not been that bad even in Italy and Spain, where it decimated the healthcare infrastructure and killed tens of thousands. He concludes that the difference between Norway’s 200 deaths and Swedens’ 2000 deaths is statistically negligible, and therefore social (physical) distancing measures don’t actually matter. He does this because, again, he’s invented a sufficiently high denominator for his “prevalence” that literally any number of deaths is going to seem “insignificant,” at least statistically.
Sweden’s Population: 10.2 million.
Deaths in Sweden (without mitigation strategies): 1,765
Norway’s Population: 5.4 million.
Deaths in Norway (with mitigation strategies): 182
14:30 Dr. Erickson: “1,700 (deaths), 100 (deaths); these are statistically insignificant.”
I want you to stop and say that out loud a few times. Go ahead.
These lost lives are not insignificant; statistically or otherwise.
One more thing I remember specifically, because it was so shocking to me at the time. He goes on to talk about the way that the mortality data is being ‘manipulated’, even saying that a deceased patient with COPD (Chronic Obstructive Pulmonary Disease) who contracted COVID-19 has not actually died of COVID-19, but from 25 years of smoking… As though the medical vulnerabilities that predispose a patient to becoming a victim of this horrible virus and the pathology caused by the virus itself are mutually exclusive. As though tens of thousands of COPD patients who have been smoking for decades were suddenly going to go into respiratory distress in April 2020, apart form any exacerbating factors, and their happening to have the virus that is also killing people with heart disease, diabetes, compromised immune systems, and even the young and healthy is just some weird coincidence.
Bad at statistics is one thing. This is bad at being a Doctor.
I want to begin by acknowledging that the headline to this article is quite snarky. While I try to write about these issues of medical misinformation with some degree of charity towards those I disagree with (and often fail at that), writing titles to posts doesn’t allow for quite so much nuance; I honestly find it to be the most challenging thing about blogging.
Here is a video that was recently shared on my friend’s Facebook timeline. It is mercifully short (less than 5 minutes) and I have included the link for those who would like to watch it in it’s entirety. My friend is an Emergency Physician in New York state, and she was probably on shift when this was shared to her wall. Later on she did leave her own comments, and I have chosen to include some of them, and snippets of our conversation afterward, in this blog post. Let me tell you why.
I tend to believe that while the people generating these conspiracy theory videos are motivated by desire for some combination of fame, power, or fortune (and this video may well be an exception to that) the people who are sharing them widely on social media and forming opinions based on them are more victims than accomplices. They are being given false information exactly calculated to appeal to their fears, their political leanings, and their preconceptions, and they are deciding to place their trust in these so-called experts because they themselves do not have the background or knowledge base to parse the information on their own. Without a background in statistics, medicine, epidemiology, etc. they feel they have no choice but to trust one “expert” or the other, and all too naturally quiet their own discernment and choose the one that reinforces their own views. The problem is that while one group of experts have devoted their lives to rigorously studying disease and the human body so that they can help those who are suffering, the other group of “experts” are actually only experts in engendering this sort of trust, and not in the areas of knowledge they claim to understand; they are essentially false information experts.
Because of this, I do try to approach these topics with gentleness, recognizing that it is easy to be deceived and hard to sort truth from fiction. I have that privilege because right now the COVID-19 pandemic has really impacted my life quite minimally, compared to the rest of the world. Katie is still homeschooling and I am still going into work. We haven’t hit a surge yet and so while I have seen COVID-19 patients, and we have had some deaths due to the virus in Waco, I am not being called upon, at this time, to work extended hospitalist or emergency room shifts trying to care for patients in an overwhelmed hospital with physically and emotionally exhausted staff and colleagues.
But my friend is working under exactly those circumstances, and if she’s a bit more adamant than I am about how hurtful, how dangerous, and how dehumanizing these types of nonsense and lies are to not only the victims of this terrible virus, but also to the healthcare workers fighting it… well, I think she’s perfectly entitled. Please trust me, if she found these falsehoods shared on her Facebook wall by friends or family members when she came home from a shift where multiple patients died or were admitted to the ICU due to COVID-19, she could be considerably more vociferous if she chose.
I’d like to devote a separate essay to the the main point of his video, which to him constitutes “100% proof” of fraud and a major international conspiracy lead by WHO and the CDC, and apparently involving doctors and healthcare workers across the globe. This revolves mainly around CPT codes, and the “two CPT codes” being used for COVID-19 in order to cook the books “right in front of your eyes.” We are going to go into this in more detail, hopefully sometime in the next 2 days, but first I want to discuss the other issues he raises in the video.
At the 1:46 mark of the video, Mr. McCarthy says, “Here’s a document from the CDC dated July 2020 (Note: this means that the article is due to be published in July, not that this article is from the future, as helpful as those would be if we could get our hands on them) that clearly states…”
“In addition, our findings suggest that home isolation of persons with suspected COVID-19 might not be a good control strategy (McCarthy: Oh there’s a shocker!). Family members usually do not have personal protective equipment and lack professional training, which easily leads to familial cluster infections.”
He concludes, “meaning it’s making it worse, not better folks!”
This is a direct quote from the study below (image links to full article on CDC website).
His point here seems to be that having people who are actually suspected of having the virus stay medically isolated at home is actually worsening the pandemic. Which is… pretty nuts. We are not even discussing broad based social/physical distancing measures and shelter in place orders here, but actual management of suspected cases. It’s hard to imagine in what way, or compared to what strategy, having these patients isolate at home would make things worse. Would he prefer for patients with suspected COVID-19 just go back to work, despite their cough and fever, and wait for their test results? Does he think that patients wouldn’t be in their homes exposing their families at all if not for doctor’s orders? He doesn’t say, but the implication, in the context of the rest of the video, is that having patients who are actually ill keep themselves at home and away from the general public is yet another tool of the COVID-19 conspiracy… As opposed to being a common-sense step we already take for pretty much every other contagious illness.
It’s hard to know whether Mr. McCarthy is simply confused in thinking that the article’s point is that home isolation is too draconian, or if he is intentionally drawing the wrong conclusion in order to deceive his listeners. Sadly, I think it must be the latter, because the very next sentence of the article reads as follows:
“During the outbreak, the government of China strove to the fullest extent possible to isolate all patients with suspected COVID-19 by actions such as constructing mobile cabin hospitals in Wuhan, which ensured that all patients with suspected disease were cared for by professional medical staff and that virus transmission was effectively cut off.“
So the opinion of this articles authors is that having suspected COVID-19 patients isolate at home is not nearly extreme enough to prevent spread of this virus, and that patients should be kept in mobile hospitals instead. Considering that his very next point is that hospitals are manipulating the COVID-19 data to make money, we must concluded that his omission of the very next sentence and his substituting his own conclusion, which is the exact opposite of that drawn by the study’s authors, is actually intentional.
Hospitals are miscategorizing people as COVID-19 patients because of the CARES Act.
This claim, which is implicit throughout the video, is explicitly stated at the 2:56 mark:
“All they have to do is use the right code! Why aren’t they using it? Because the average COVID-19 case for medicare or medicaid is between $13,000 and $100,000 right now folks. So by flipping this number to this number (pointing back to the CPT codes), the hospitals are making a tremendous amount of money off of medicare and medicaid… It’s absolutely fraud.”
Now, there’s a lot wrong and just plain silly with his take here. There’s the fact that our healthcare costs in this country are so inflated (largely because of the hospital-insurance company arms race) that those numbers, which he means to be a ‘they are charging how much!?’ moment… really aren’t all that shocking (also, that’s a pretty big range there). There’s the fact that using one COVID-19 code vs. another based on whether a test was positive isn’t going to affect billing or epidemiology data (we are going to go into this in more detail in the next blog post). And there’s the fact that this really does seem like the type of information that, like the last example, actually proves the opposite of his point if it proves anything at all. Many patients with COVID-19 are incredibly, unbelievably sick and require high levels of support and prolonged hospital stays (we have been closely following the story of a man here in town, a friend’s brother, who has only just returned home after over a month in the hospital, including an extended ICU stay), and quoting numbers about the exorbitant expenses associated the disease really shows two things; we need to move away from a for-profit model of healthcare in this country, and this is a very, very bad bug.
But unlike nonsensical theories of 5G towers reprogramming our DNA or defeating COVID-19 by doing a cellular health detox cleanse, most Physicians are not so quick to dismiss the idea that some in hospital administration and corporate medicine might see government provision for COVID-19 treatment, such as that provided in the CARES Act, as an opportunity to profit; or at least to make up for lost revenue from cancelling elective surgeries and decreased admissions leading up to any COVID-19 surge. I have known hospital and clinic administrators I trust implicitly, and I have known hospital administrators who have lied directly to my face; but most probably fall into a very broad category of people who just have different values and convictions around what medicine is supposed to be than I and most other Physicians hold to. At the end of the day, I tend to think it’s a bad idea in general to have the practice of medicine driven by, in so much as it is driven by, people who have studied and been hired to increase profits and market shares rather than people who have taken an oath to do no harm and to aid the suffering. It would be somewhat naive to expect that dynamic to disappear entirely in a pandemic.
But let me be clear; if a handful, or even a large number, of unethical hospital administrators are actually trying to commit fraud to gain access to additional payments related to COVID-19, either by attempting to influence clinician decision making or by actually modifying medical records, those people should be convicted. But even if this were the case, I do not believe for a moment that such activity has any way of significantly changing the hard data we are seeing, for a few reasons.
First and most importantly, the numbers we are seeing do match the experiences of doctors and nurses on the ground. Doctors have a good gauge for what a bad flu season looks like or when a viral GI bug is going around, and generally have a bead what is happening with the health of their communities. It is absurd to believe that doctors and nurses who are suddenly fighting for their own and their patients’ lives against this horrible virus have all been wrapped into some big conspiracy to profit hospital administrators and stock holders. That’s why the ‘hospital administrator cooking the books’ (note to self: new idea for a Les Mis parody song) idea tends to be a final redoubt for conspiracy theorists once they have been confronted by actual doctors and nurses, who in the cultural atmosphere since COVID-19 they no longer feel they can get away with calling liars and conspirators directly to their faces.
But it also doesn’t make any sense to equate medicare or medicaid fraud related to COVID-19 to an inflation of the epidemiology data, because even if EVERY hospital administrator were in on it, they would still have very limited influence on that data. They would not, for instance, be driving to community based and free standing labs to convince lab techs to report positive tests, so they would have a better COVID-19 paper trail if those patients showed up in their ER’s later. They are not going to unaffiliated, clinics and underserved healthcare centers and convincing Physicians, NP’s and PA’s to fudge their evaluations to make COVID-19 look more prevalent. They are not telling ICU and Emergency Room doctors when a patient’s respiratory status is sufficiently dire to require a ventilator (I have actually heard of such cases in the past, and those administrators were promptly reported for practicing medicine without a license), and at any rate if they were they would be ignored. They are certainly not killing people; it is the virus that is doing that.
Just like with pharmaceutical companies, insurers, drug reps, home medical equipment companies, and so, so many other players in the healthcare arena, Physicians have complicated and often antagonistic relationships with hospital administrators. But even if you believed that every single hospital administrator were corrupt and currently working overtime to try to game the COVID-19 situation, there are just so many other people involved in tracking this data. There are epidemiologists and infectious disease doctors, the local public health department, the coroner’s office, local and state government officials of all political influences, and many, many people evaluating this data from every possible angle to see what we might be missing, or what patterns might help us be prepared for what comes next. And finally there are the people living through this pandemic; the doctors and nurses and respiratory therapists, yes, but also the patients, those living and those deceased, and their friends and family and loved ones. These are the people who are robbed of their dignity and their opportunity to grieve and process in peace when people like Daniel McCarthy erroneously claim that COVID-19 is being blown out of proportion to make money for a fairly small group of businessmen.
The flu kills more people anyway.
It’s hard to know exactly what point he’s trying to make by touching on influenza death and hospitalization data toward the end of the video. My hope is that he’s merely pointing out the importance of having reliable data. If so, I would agree with him, although from the rest of the video I don’t think I would trust him to recognize it once we had it. Unfortunately, however, I think he is simply reviving the ‘it’s just another flu’ rallying cry that we’ve heard consistently for months from those ignoring the realities of the COVID-19 situation; if that wasn’t his intent, my apologies to Mr. McCarthy; it’s a good thing for us to talk about here at some point anyway.
I’m honestly so sick to death of this one. It is the end of April and I am sure that this has been explained to Mr. McCarthy several times by now, so I can only assume he has chosen to perpetuate the lie that COVID-19 is ‘basically just like the flu’ because it fits with his narrative, and not out of actual ignorance. I hope I am wrong about that. I won’t go into extensive detail (I have included a link to an article below), but essentially the flu is a partially vaccine-preventable virus that demonstrates seasonal prevalence and has a high rate of mutation. Because of this, epidemiologists have to try to predict which strains of seasonal flu are likely to be prevalent in the coming flu season so that vaccines can be prepared. Some years these are more effective (and more widely accepted) than in other years, and some years the seasonal flu strains are more dangerous or more widespread than other years. This means that seasonal influenza has the potential to be very, very bad in any given year; but also that there is a high degree of variability.
In addition to flu vaccines, there are several mitigating factors that help keep the flu from overwhelming our hospitals and healthcare infrastructures every Winter. First, flu season is fairly long; usually above 3 months, with a high degree of chronologic and geographic distribution. This means while hospitals are sometimes extremely taxed by the flu, it is rare for them to actually be overwhelmed; though there are certain years and certain locations that come very close. If you consolidated the impact of even a light flu season into a 1 month period, affecting every community in the country at roughly the same time, it would absolutely overwhelm our healthcare systems and people would begin to die not just from the flu but also from our inability to provide care for other conditions while battling it; and this is exactly what COVID-19 does threaten to do (and has done) because of it’s much higher degree of infectivity and, likely, higher degree of asymptomatic or minimally symptomatic spread compared with influenza.
Second, we know the flu is coming. Each year Physician, Nurses, and other healthcare workers make strategic decisions leading up to flu season. When I have taken leave to work internationally, we have always scheduled that time during the late Spring or Summer, when I knew I would be less needed because we wouldn’t be in the midst of fighting the flu. Staffing decisions and other resource organization is made based on the expectation of a surge, even if the exact timing and parameters of that surge are unknown. With COVID-19, there was no preparation time in those regions that were hit earliest, and the rest of us have been scrambling ever since to ensure that our systems are ready for a surge that is unpredictable because there are no decades of past data to help us now what to expect at our hospital or in our region.
Third, we already how to deal with the flu. While influenza seasons and symptom clusters do vary, the syndrome is very recognizable and we generally have a good idea of what to expect with flu cases, and how they interact with other acute and chronic illnesses. As several quotes I’ve read recently have said, “The flu is an old enemy.” Yes, it is a very, very dangerous enemy, but it is definitely ‘the devil we know’ compared to COVID-19. We have years of research and clinical experience to help us. We know which medications have modest therapeutic benefits and which have none, and what strategies to use when patients present for dangerous complications of the flu, such as post-influenza bacterial pneumonia, or when it causes complications in preexisting lung disease. With COVID-19, new data is still emerging continuously about both the strange spectrum of harm that this virus causes, and the possible treatment approaches; those fighting the virus later in the course of this pandemic really do stand a better chance of both diagnosing it accurately and treating it effectively.
Finally, the flu itself is already bad enough, and dismissing COVID-19 as ‘basically another flu’ just shows how the people spreading these ideas are already in the habit of dismissing incredibly dangerous infectious illnesses. Already COVID-19 has killed more people in the US than almost any flu season, and yet people are still waving it off as ‘another flu’ the way they were weeks ago when it had ‘only’ killed a few thousand. In the coming days the total number of deaths in the US will surpass the 62,000 mark set by the 2017-2018 flu season, the worst we’ve had since I’ve been a Physician. Once this benchmark is passed, will these conspiracy theorists finally abandon the ‘it’s just like another flu’ argument, or would they like to hold on to it until COVID-19 has actually surpassed the numbers set by the Spanish Flu pandemic in 1918?
As might be expected, there are a great many videos and articles about health surfacing right now during the pandemic; it’s a topic that is firmly on all our minds, even more so than usual. Unfortunately this means there is a lot of misinformation out there. I am actually really grateful when friends and family ask for my input on health information; I think informing our communities and using our education and experience to aid in the challenging work of discernment in this area is really important work, and one of the roles we need to engage in as Physicians. That said, there is so much misinformation out there right now, and life is already so busy because of the work of fighting the virus itself, that I have pretty much given up on addressing each article or video point by point in the way I normally would. I tend to be excessively verbose so you could imagine that cutting back is a challenge for me!
First, I would say that a good place to start, really with any of these articles or videos, is to ask whether the source is a reliable source of truth, a frequent source of falsehood and misinformation, or something in between. I don’t mean that we could write someone off because they have been mistaken (even brazenly mistaken) in the past, but simply that it is helpful to know their track record of veracity as a starting place for any new claims. It is important to know if the source has, as Chesterton put it, “revealed itself as a truth-telling thing.”
With that in mind I would encourage you to do some research on Dr. Pompa as a backdrop for understanding his perspective. He is not a medical doctor or a scientist. He has a degree as a Chiropractor. A discussion of alternative medicine in general is outside of the scope of this discussion, but I will say Chiropractory is a widely varied field in terms of adherence to scientific evidence and even basic medical ethics. I have known very good chiropractors who genuinely wanted to help with people’s pain and believed their methodology was superior to (or more often, worked in combination with) traditional approaches such as physical therapy, exercise, etc. My parents see a Chiropractor to this day and he came to all of our new year’s gatherings growing up; I like him very much as a person, and I’d like to think they are mostly like that. There are also, unfortunately, some Chiropractors who have discouraged patients from following the advice of their Physicians and receiving necessary treatments, and convinced them instead that a realignment of their spine can cure everything from diabetes to cancer. I have known some to sell unbelievably expensive and entirely unproven supplements from their offices and branch into other facets of alternative medicine even more dubious. Sorry to digress; all of that is to say, we don’t know what kind of Chiropractor he was, but when he speaks on virology, immunology, and microbiology, we need to understand that he is by no means speaking as an expert, or as someone who has actually trained in those areas of study extensively (though I’ll be the first to admit that I don’t actually know how much microbiology and immunology is taught in Chiropractor school; if a Chiropractor reads this and disagrees with my assessment, please feel free to lend your insight!).
Further, I think it bears pointing out that he is no longer practicing Chiropractory. As best I can tell, his license with the Pennsylvania board of Chiropractors has been on probation since 2014. To be fair, this was due to “moral turpitude” over a civil issue (which you could google if you wish, but I won’t share the details of the case here) and not due to issues related to his practice (this is of course assuming I have the correct Dr. Daniel Pompa, Chiropractor. I am ready to retract this information if someone is better at google than me and it turns out to be a different guy!). He currently works as a “cellular healing” and detox consultant and, as far as I can tell, all around alternative health huckster. His website and blog are absolutely full of dubious claims (though I’ve seen worse) and, of course, are oriented around a (presumably) expensive and unproven service that he can provide. Only Dr. Pompa has the key to unlocking your cellular health!
So, what’s the most we can say about Dr. Pompa so far? We know he trained in a fairly mainstream, regulated alternative medicine field, but is no longer able to practice in that field for legal reasons unrelated to chiropractory itself. We know that he now works in an entirely unregulated field of holistic healing/alternative medicine and puts himself forward as a “cellular healing and detox” specialist, which are not real areas of medicine. We also know that he is a very gifted communicator. He is handsome and well spoken, he dresses well and is likable on video, and most importantly he uses the combination of “common sense” arguments and pseudo-science vocabulary that is what makes alternative medicine seem especially convincing; the terminology all seems like the right type of terminology, but there is nothing here that you could say ‘well that doesn’t make sense’ to (in contrast to what C.S. Lewis says about things that are actually real; “the problem is not simple and the answer is not going to be simple either”).
So, with all of my initial apologies about brevity, I find myself out of time and having not even addressed the video itself. To be fair, I didn’t know that there would be so many cautions to share about Dr. Pompa when I first started to research his career. Honestly, that ought to be enough; he is someone who has made a career out of selling unproven treatments based on empty scientific-sounding vocabulary and personal presence alone, once ‘mainstream alternative medicine’ would no longer allow him to practice, and his video above is convincing, where it is convincing, primarily because of these two factors. But I do believe that it is worth addressing the content of the video itself, and if you’ll give me leave I will attempt to do so in a few hours after my children are in bed!
I’ve watched the video a couple of times and taken down a few quotes, but I’d like to start with a short preamble: It’s really not all that bad. Please understand, I’m not saying it’s true; if I were a fact checker I would have no choice but to categorize it as “fake.” But my standard for misinformation has probably shifted a little during this pandemic, and this video is pretty benign overall. Like so much of the alternative health industry, it is an uneven and patchy mingling of truth and falsehood, so you couldn’t say “everything he said is dead wrong.” This is one of the problems with this industry; people who are in it REALLY believe in it, much of the time, and often have a few scientific facts or principles down but without any supporting context or science education, so they easily believe entire narratives that are built up around those few isolated truths.
I’m also not quite sure why he’s making the video. I suppose that in his line of work fame and notoriety do lead directly to financial success, and we are seeing a lot of people in alternative healthcare trying to use the pandemic to make a name for themselves and be seen as an expert. There’s certainly plenty of evidence of that in the video, from him saying ‘bottom line the experts have missed it’ to ‘this study confirms my point’ and lots of other subtleties of language intended to convey that he is the true expert on health and the poor guys at the CDC and WHO just don’t know any better. So, maybe that’s part of it; that is certainly the name of the game in that industry. But I’d like to overall give him the benefit of the doubt and say he really believes his message and wants to get the information out there; maybe I’ve been duped because he’s just so darn handsome so I’d like to believe him.
The problem is that it just isn’t reliable information. There are a few extremely egregious falsehoods, and we might as we’ll get them out of the way now.
“They’re looking at the death rates just sinking around the virus, saying ok it’s probably more like 0.1% at best, which is basically the same as the regular flu.” “The bottom line is the experts have missed it.”
-I have no idea where he got this information from. Maybe he heard it somewhere but misinterpreted it? The ‘no more dangerous than the flu’ line seemed to have quieted down for a while as the pandemic spread, but has resurfaced as social distancing and containment measures have proven effective; it’s a very easy thing to say when you don’t have family and friends who are in the ICU or have died from the virus, and in many places there are so few severe cases that it’s easy to believe that COVID-19 “wasn’t actually that big of a deal”, as though the pandemic 1. Hadn’t already killed over a hundred thousand people, and 2. Was already over and done with. This is something public health experts and lay people alike have been saying since the beginning; if the extreme measures we take now actually work, people will say they weren’t necessary. In places where the healthcare system is particularly overwhelmed, the case fatality rate remains above 5%; astronomically higher than seasonal influenza. In places where the healthcare system can cope with patients at a more routine pace, without running short of either Physicians, Nurses, other support staff, or equipment, the rate is much lower; but still on the order of 2%, not 0.1%. This is an incredibly deadly disease, and before anyone buys into the conspiracy that this was all hype pushed on us for this purpose or that, they should open themselves up to the images and stories coming from Washington, New York, Louisiana, Italy, and Spain. I am sure we will soon enough be told that those people were all “trauma actors.”
The biggest question mark in all of this, of course, is the lack of universal testing. Our testing policies so far have been driven by test scarcity, and there has ALWAYS been the assumption that as more testing on asymptomatic or minimally symptomatic patients occurred we would find a large cohort of people who were more or less healthy despite having the virus. But we are still very, very early into having this sort of testing anywhere, and from colleagues in healthcare system that DO have universal testing policies I am hearing that they just aren’t seeing many asymptomatic carriers. So although we will not be able to come to a final estimate of the death rate from this virus until all is said and done, so far it is too early to see the drop in the death rate due to asymptomatic cases that we all have expected.
“But because they are attributing many different conditions to Corona it’s probably even half that.”
-It’s hard to know what he means, but I believe he is referencing the conspiracy theory that someone is either inadvertently or intentionally inflating the death rate for COVID-19 by attributing deaths due to other conditions to the virus. I’ve addressed this in detail a few days ago on another Facebook post; I am happy to share it with you if you would like.
“Now we know it was a narrow group of people that were truly at risk for this virus.” “You can tell from my past videos that I am not one to have been fearing the virus.” “People are realizing that it’s not as dangerous as we thought and they want to get the antibodies…. Because if this mutates we could all be at risk.”
-This is a bit revisionist. He is making it sound as though we initially thought that every person had a big risk of ending up hospitalized or dying from COVID-19 and now we know it is only people with certain risk factors such as age, other medical conditions, immunocompromise, etc. This is actually the exact opposite of the true history of our understanding of COVID-19, and it was shocking when reports of death in young healthy people began to come out of Europe and then began to occur in the United States as well. Of course older people with medical problems are at higher risk; that is true for any infectious disease. But this is a virus that is, in fact, dangerous even for people who are young and healthy. We are ALREADY all at risk.
As far as the second quote goes, please do not be fooled; this disease is dangerous enough that TRYING to get the antibodies “naturally”, by intentionally being exposed to the virus, would be incredibly foolish and irresponsible. Vaccines were invented because some diseases are so dangerous that taking a chance on the live, unattenuated pathogen is the same as gambling with your life.
“They put things into place not understanding the risks…”
-I’ve included this because, briefly, I think it illustrates this concept of setting oneself up as an expert that is so common in these videos. The idea here is to convey that the people in charge, the epidemiology experts and virologists and the people who have actually spent years and years studying human disease and microbiology and human immunology, all meant well but just didn’t know or understand what he does. He goes on, as we’ll talk about below, to discuss the hygiene hypotheses of autoimmune disease and the ‘dangers’ of wearing masks, and if you connect the threads it really seems as though the physicians and researchers who have recommend ways to slow the spread of the disease just aren’t familiar with the principles he is referencing, which is of course preposterous. Please note, however, that he is releasing this video NOW instead of 2 or 3 weeks ago; now that the “things they put in place” have actually shown some measure of success, he has the luxury to say that none of it was necessary.
The Hygiene Theory
After this, we finally get into the real meat of his argument. He starts by quoting a study, “having fewer sanitary amenities in childhood is linked to a lower risk of having inflammatory bowel disease.” This is a basic concept of the hygiene hypothesis, that exposure to certain microbes is necessary and decreased exposure leads to multiple disease, including autoimmune disease. This is a valid scientific theory with a good bit of evidence. Like most things in medicine (or for that matter, most things in real life period), it is much more complicated than it is presented here. It would be dangerous, for instance, to presume that because some bacteria, viruses, and fungi are important to our growth, development, digestion, and the functioning of our immune systems, that therefore ALL such microbes are healthy and beneficial and we were wrong to want to protect ourselves from them. Concluding that because exposure to more microbes is linked to decrease in risk of inflammatory bowel disease, we should expose ourselves to ALL bacteria and viruses including the one that causes COVID-19, would be particularly illustrative of the clinging to a few points of medical data without actually understanding them that we talked about before, which is so emblematic of this industry.
“The whole point of all of these studies is that more the viruses, bacteria, and pathogens you are exposed to the healthier your immune system is.”
-I cheated there, because I knew he was going to say that already as I was writing that last paragraph. What he’s done is taken one category of disease and one set of risk factors for those diseases, and conflated them with all of human health in general because the words happen to be the same. Because disease, bacteria, and microbe all appear in both discussions of the hygiene hypothesis of autoimmune disease and in concepts related to infectious disease, he believes that data from one can be used to negate data from the other. It is a basic failure to understand the concepts and even the terminology that is being discussed. To put it more simply; he is stating that because some bacteria are good for us, bacteria can’t be bad for us. He probably doesn’t really believe that, but the implication is that if your immune system is healthy enough then everything that would make others sick will just make you stronger.
The failure here is to distinguish between viruses, bacteria, and fungi in general, and pathogens, which are viruses, bacteria, and fungi (and other fun little guys) that cause diseases in humans. Avoiding pathogens that can make you sick is the most basic way of avoiding dying from some of the most painful and devastating killers in our fallen world. It’s the reason we don’t eat raw pork and why we wash off a cut. It’s a very basic concept that is taught even in high school biology, and it isn’t confusing to anyone in the medical field. It isn’t really confusing to anyone at all, until the obfuscation occurs in videos like this. The alternative health industry, and particularly those sectors of it that are focused on ‘restoring natural immunity’ and establishing healthy gut flora, etc, need to convince you that they are the only ones that really understand these concepts, so they obscure simple ideas, minimize complicated ones, and conflate terminology until they have a version of our complex immune systems and interactions with the world around us that is almost, but not entirely, completely untrue. They would like you to believe that everyone else is confused; that doctors think all bacteria are bad and want to sterilize your microbiome and gut flora with antibiotics and hand sanitizer, and can’t distinguish between the presence or absence of an infectious disease. There was even a video recently where an alternative health partisan claimed that doctors don’t study the immune system in medical school at all, which is obvious nonsense. And in trying to convincing you, they do convince themselves.
“Before this we had the hygiene theory: run from bacteria, kill all the bacteria” “Let’s not throw a whole decade of research out the window”
-Again, just to be clear, the hygiene hypothesis IS the theory that decreased exposure to microbes increases the risk of certain diseases. And the theory and research around it has been around for decades. I find it concerning that he keeps exactly inverting the concept of the one scientifically valid theory upon which he has built his entire pseudo-medical philosophy, and then calls it a failed theory that we have to abandon. In his defense, it is a misnomer, since avoiding non-pathogenic microbes has nothing to do with hygiene.
“If I was going into a group of people that was at risk I would wear a mask….” “It wasn’t about killing bacteria and viruses and pathogens, it was about living with them.”
-You might notice, as you watch the video, that he frequently shifts between treating the virus as something to take seriously and something we should live alongside and go ahead and ‘get antibodies’ to as early as possible. We haven’t really beaten this thing yet, so I don’t think that the people making these ‘it isn’t so bad’ videos can be quite so brazen in saying that the virus isn’t dangerous, no matter how much data their audiences are generally willing to ignore… at least, not yet. He is willing to tell you that you should keep your grandmother or immunocompromised friend safe by wearing a mask around them, but at other times in the video he encourages you to touch your face and implies that we need to take this opportunity to get exposed before the virus mutates. In 2-3 months we will see many articles and videos of people telling us that we missed our chance to have “COVID-19 parties” and that this is because big pharma and their pawns, doctors and nurses, want to suppress our natural immunity so they can sell vaccines. But those videos will have to wait until people stop dying from this virus. SARS-CoV-2, at least for the time being, still has to be respected as a pathogen.
“The hygiene philosophy failed. The antibiotic era, hand sanitizers, all of it has FAILED.”
-Let’s be clear; hygiene measures associated with germ theory have saved more human lives than any other intervention in medical history (vaccines and antibiotics are also in the top 5). It is ludicrous to say that hygiene doesn’t save lives. There are places in the world and in the United States where we STILL see the devastating effects and widespread disease and death associated with lack of access to clean water and basic hygiene measures. This is a privileged belief from every standpoint; chronologically, geographically, socio-economically. Living in a hygienic environment with potable water and clean, nutritious food, he has the gall to say that hygiene is a failed concept. He would like us to use the word ‘hygiene’ as a synonym for his red herring of ‘sterile’ and believe that doctors and public health experts want us to never be exposed to the world around us, which is patently false. He then wants to conflate the hundreds of years of excellent hygiene and microbiology work that has been done, which has saved billions of lives, with his own narrative that if they had their way doctors would have us all living in white rooms wearing gloves and afraid to let our kids play in dirt. Why? Because thoroughly undermining generally altruistic physicians and nurses that practice actual evidence-based medicine is very good for the alternative health business.
“The true risk of what we’re calling the new normal.” “People with masks and gloves”
-Please wear masks. Please treat the virus like it can cause terrible respiratory failure and kill you, because it definitely can. Nobody is recommending you lysol your house daily (but please do it to the kitchen counter if you are cutting raw chicken, because Salmonella is a bacteria that IS a pathogen and can also make you sick). Your kids can play in the mud; they can do it today, if you’ve got some mud in your back yard and nobody has been over to cough on that mud. Wearing masks every day of our lives, not hugging each other, avoiding social gatherings, avoiding dirt and trees, and cleaning everything we touch are not practices that have ever been espoused by Physicians or public health experts. Taking precautions as individuals when we are ill, and as a society right now because a particular, new, deadly virus is currently spreading in our communities and threatening to overwhelm our ability to care for those affected, is something we espouse; and I believe that, regardless of what some people might want us to believe, most of us have the common sense to see the difference.