I disagree that you have proof that the vax is not contributing to more athletes deaths. I have never heard of an athlete dying suddenly in any sport, (and I am almost 50), before Covid vaccines. Mandrola had an example from 1997. One example. Interesting. Covid has been the ONLY time a vaccine was required for players. Honestly, Vinay, until you have actual data supporting your bias that it isn’t connected, I would stop saying it isn’t. The truth is, no one really knows.
Yeah, I'm dealing with the problem of trust in the system of medicine at the moment. I've been dealing with a recently emerging persistent health problem. But I can't know if going to the doctor will get me the best treatment. Although I think I recall my main doctor's office having created a Substack. But that was before I ended up coming to the platform. So maybe I should find out if they're more trustworthy than I think.
The comment about athletes dying has me concerned. The shear number of deaths in the last few years outnumbers by multiples the number of athletes dying in the prior years.
Hi, Vinay. I'm an ID physician. I agree with many of your observations and premises but not so sold on your overarching conclusion that physicians need to remain politically neutral.
It seems ultimately difficult to segregate health and medical questions from political issues. There's an entire essay by the sociologist C. Wright Mills called "The Promise" where he talks about the sociological imagination--the view that almost all personal troubles as ultimately rooted in social issues. It does not specifically tackle health care and medicine but I see the patient's medical problems and the issues around the physician-patient relationship all as personal troubles.
In fact many of the questions you have weighed in on these last few years--community mask mandates, mandatory vaccination, school reopening--were questions of health policy but ultimately were also political questions. And you answered them from your perspective that was informed by your expertise and experience as a clinician and a clinical epidemiologist.
I agree it seems ridiculous to comment on nuclear war--something no one wants. But I don't think everyone is on the same page on whether climate change is happening, whether human beings have a hand in it or whether we can do something about it. But physicians will be dealing with its health consequences and it seems something we ought to be wading into.
Will it backfire and foster mistrust? Honestly I think I'm much more jaded than you. I think it doesn't matter. People will mistrust physicians when physicians tell them what they don't want to hear, whether physicians are being judicious and fair in their messaging or not. I think the relationship between medical authorities and the public is toxic, even if medical authorities did things your way.
My bias being as a Preventive Medicine and Public Health physician (pending upcoming board exam), I don't see how you can disentangle medicine from politics. The government is the largest payor of healthcare and insurance is a huge part of our national budget and an area of public debate. The idea that someone wearing a white coat can't or shouldn't have an opinion on the subject is untenable. The same conclusion applies in niche areas.
But there's a difference between being political and being partisan. Healthy institutions would recognize that most people are neither Republicans or Democrats, that no political standpoint has a monopoly on truth, and would support a wide range of views. Clearly, that is not what is happening in medicine or in academia.
You have observation bias. There is no shortage of Republican doctors outside of the coasts. I trained in Alabama and practiced In Missouri, Montana, Oklahoma plus Texas. Republicans are likely in the majority in most of these states. Don’t feel they are being repressed or endangered in anyway!
Vinay, why don't you debate Peter McCullough, using data? That would be truly interesting and informative. If you write off someone like him, whose advice re ivermectin literally resulted in some of us getting relieved of covid symptoms in a couple days (do you really believe someone diagnosed twice--I wanted to be sure--could avoid symptoms by wishing??), this is cause for many to find you not credible.
Vinay, if you believed that docs should be quiet about things that imply politics, you’d be quiet about masks. We need people with you training, experience, and proximity to humanity to weigh in on policy issues. One of the reasons that is important is to show the outcomes of policy decisions and the ripples that you see in your role. It seems that one thing you push for and we need more of is to push for space to disagree (rather than to not ever address issues beyond chemo doses or stenting...which you already do. Also, to decide that this or that issue you feel knowledgeable or strongly about and this other issue you don’t ...which you already do). You may support things as a person and not a doc of your specialty, but your training gives you a perspective as a person we need in our communities.
Fun fact: voters don’t register for a political party in Washington state (where I live) per state law. I wonder how/if that impacted Covid deaths per political party (not sure what other states similarly don’t register your party preference).
Disagree. An opinion on masks mandates is very much in the medical universe. War in Ukraine and nuclear war are utterly irrelevant, except as citizens, which is precisely Vinay's point.
I agree the conclusion reached in the medical versus angioplasty study was ridiculous. However, when you read the study, 30% in the medical group crossed over into the PTCA group, presumably when they became unstable. how does that figure into the statistical outcomes? I think approximately 17% of the PTCA group crossed over to bypass surgery. It seemed the more invasive/interventional approach were the life lines for the two study groups. I also wonder what the selection bias was to determine who proceeded to randomization based upon the initial coronary arteriogram.
Who cares about athletes in the news? The stories of a relationship between the Covid vax and deaths are coming from everyday people and being confirmed by a small number of pathologists. When a friend or relative talks about problems with the vax, people tend to believe it.
I love these discussions but trying to relate the need to address sharing information to lower income people put you out over your skis. Everyone is hit with fees and costs that are skimming. Everyone has some fee to get access to their job and if you want support then go broader. The pay to play model is broken for most people and that’s where commonality is found.
@npr also promoted another garbage study a few years ago which tried to make hay of the observation that more red leaning counties had higher "per capita Covid death rates" than blue leaning counties. First off, this is a stupid, divisive political question to pose, and it also ignores that more red leaning counties are rural and lower population density.
If you looked at the TOTAL number of deaths from Covid, far and away more of those deaths occured in blue counties... more urban and population dense.
Create a pre-print server, which number one does not censor, and number two uses some sort of a reputation based system for allowing and promoting responses.
Much like as used in the tech world on websites like Stackoverflow. When you show that your critiques are objective and appreciated by your peers, you get up votes, and that gives you more clout and ability to critique other pre-prints. If you have a low reputation score, you don’t have as much cloud in terms of critiquing, or voting a pre-print up or down.
Re the PTCA study's ridiculous conclusion, I see another conflict not mentioned by Vinay and John. Namely, cardiologists have a financial incentive to do PTCA. Hence, study authors have a strong motivation to spin a conclusion that promotes PTCA, even if counterfactual. Non-cardiologists involved in the study, such as statisticians or journal editors, are "members of the club", and know they should play the game.
I disagree that you have proof that the vax is not contributing to more athletes deaths. I have never heard of an athlete dying suddenly in any sport, (and I am almost 50), before Covid vaccines. Mandrola had an example from 1997. One example. Interesting. Covid has been the ONLY time a vaccine was required for players. Honestly, Vinay, until you have actual data supporting your bias that it isn’t connected, I would stop saying it isn’t. The truth is, no one really knows.
Yeah, I'm dealing with the problem of trust in the system of medicine at the moment. I've been dealing with a recently emerging persistent health problem. But I can't know if going to the doctor will get me the best treatment. Although I think I recall my main doctor's office having created a Substack. But that was before I ended up coming to the platform. So maybe I should find out if they're more trustworthy than I think.
I enjoyed this episode, thank you.
The comment about athletes dying has me concerned. The shear number of deaths in the last few years outnumbers by multiples the number of athletes dying in the prior years.
Hi, Vinay. I'm an ID physician. I agree with many of your observations and premises but not so sold on your overarching conclusion that physicians need to remain politically neutral.
It seems ultimately difficult to segregate health and medical questions from political issues. There's an entire essay by the sociologist C. Wright Mills called "The Promise" where he talks about the sociological imagination--the view that almost all personal troubles as ultimately rooted in social issues. It does not specifically tackle health care and medicine but I see the patient's medical problems and the issues around the physician-patient relationship all as personal troubles.
In fact many of the questions you have weighed in on these last few years--community mask mandates, mandatory vaccination, school reopening--were questions of health policy but ultimately were also political questions. And you answered them from your perspective that was informed by your expertise and experience as a clinician and a clinical epidemiologist.
I agree it seems ridiculous to comment on nuclear war--something no one wants. But I don't think everyone is on the same page on whether climate change is happening, whether human beings have a hand in it or whether we can do something about it. But physicians will be dealing with its health consequences and it seems something we ought to be wading into.
Will it backfire and foster mistrust? Honestly I think I'm much more jaded than you. I think it doesn't matter. People will mistrust physicians when physicians tell them what they don't want to hear, whether physicians are being judicious and fair in their messaging or not. I think the relationship between medical authorities and the public is toxic, even if medical authorities did things your way.
My bias being as a Preventive Medicine and Public Health physician (pending upcoming board exam), I don't see how you can disentangle medicine from politics. The government is the largest payor of healthcare and insurance is a huge part of our national budget and an area of public debate. The idea that someone wearing a white coat can't or shouldn't have an opinion on the subject is untenable. The same conclusion applies in niche areas.
But there's a difference between being political and being partisan. Healthy institutions would recognize that most people are neither Republicans or Democrats, that no political standpoint has a monopoly on truth, and would support a wide range of views. Clearly, that is not what is happening in medicine or in academia.
I really enjoyed this discussion
Fantastic discussion. Keep it coming gentlemen.
I gotta say Vinay, “Vitamin D nonsense”? Really?
You have observation bias. There is no shortage of Republican doctors outside of the coasts. I trained in Alabama and practiced In Missouri, Montana, Oklahoma plus Texas. Republicans are likely in the majority in most of these states. Don’t feel they are being repressed or endangered in anyway!
Vinay, why don't you debate Peter McCullough, using data? That would be truly interesting and informative. If you write off someone like him, whose advice re ivermectin literally resulted in some of us getting relieved of covid symptoms in a couple days (do you really believe someone diagnosed twice--I wanted to be sure--could avoid symptoms by wishing??), this is cause for many to find you not credible.
Vinay, if you believed that docs should be quiet about things that imply politics, you’d be quiet about masks. We need people with you training, experience, and proximity to humanity to weigh in on policy issues. One of the reasons that is important is to show the outcomes of policy decisions and the ripples that you see in your role. It seems that one thing you push for and we need more of is to push for space to disagree (rather than to not ever address issues beyond chemo doses or stenting...which you already do. Also, to decide that this or that issue you feel knowledgeable or strongly about and this other issue you don’t ...which you already do). You may support things as a person and not a doc of your specialty, but your training gives you a perspective as a person we need in our communities.
Fun fact: voters don’t register for a political party in Washington state (where I live) per state law. I wonder how/if that impacted Covid deaths per political party (not sure what other states similarly don’t register your party preference).
Disagree. An opinion on masks mandates is very much in the medical universe. War in Ukraine and nuclear war are utterly irrelevant, except as citizens, which is precisely Vinay's point.
I agree the conclusion reached in the medical versus angioplasty study was ridiculous. However, when you read the study, 30% in the medical group crossed over into the PTCA group, presumably when they became unstable. how does that figure into the statistical outcomes? I think approximately 17% of the PTCA group crossed over to bypass surgery. It seemed the more invasive/interventional approach were the life lines for the two study groups. I also wonder what the selection bias was to determine who proceeded to randomization based upon the initial coronary arteriogram.
Who cares about athletes in the news? The stories of a relationship between the Covid vax and deaths are coming from everyday people and being confirmed by a small number of pathologists. When a friend or relative talks about problems with the vax, people tend to believe it.
I love these discussions but trying to relate the need to address sharing information to lower income people put you out over your skis. Everyone is hit with fees and costs that are skimming. Everyone has some fee to get access to their job and if you want support then go broader. The pay to play model is broken for most people and that’s where commonality is found.
@npr also promoted another garbage study a few years ago which tried to make hay of the observation that more red leaning counties had higher "per capita Covid death rates" than blue leaning counties. First off, this is a stupid, divisive political question to pose, and it also ignores that more red leaning counties are rural and lower population density.
If you looked at the TOTAL number of deaths from Covid, far and away more of those deaths occured in blue counties... more urban and population dense.
Create a pre-print server, which number one does not censor, and number two uses some sort of a reputation based system for allowing and promoting responses.
Much like as used in the tech world on websites like Stackoverflow. When you show that your critiques are objective and appreciated by your peers, you get up votes, and that gives you more clout and ability to critique other pre-prints. If you have a low reputation score, you don’t have as much cloud in terms of critiquing, or voting a pre-print up or down.
Re the PTCA study's ridiculous conclusion, I see another conflict not mentioned by Vinay and John. Namely, cardiologists have a financial incentive to do PTCA. Hence, study authors have a strong motivation to spin a conclusion that promotes PTCA, even if counterfactual. Non-cardiologists involved in the study, such as statisticians or journal editors, are "members of the club", and know they should play the game.