Author: Vinay Prasad M.D.

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An important paper came out yesterday, but not for the reason the authors think. 

Redelmeier and colleagues find that unvaccinated people are more likely to end up in a motor vehicle accident (MVA) than vaccinated people.

Let me be clear: it is ridiculous to think that lipid wrapped mRNA spike template could lower car accidents, so the only plausible explanation is that people who get vaccinated are more precautious: they may drive less, more safety, in cars that have more safety features, etc. This finding only tells you that the 2 groups are not comparable. They are different in ways other than vaccination.

The authors know that these groups are different. Their own Table 1 shows differences in age, etc. They claim however, that the association persists despite adjustment for these factors. (though they don’t have distance driven) 

What does that tell us?

The proper take aways are:

1. People who choose to get vaccinated are different than those who choose not to, and available covariates cannot capture all these differences.
2. Ergo, all vaccine effectiveness studies are confounded. They have the healthy vaccinee effect. Especially at young ages. (see forrest plot). 
3. Ergo, data for vaccinating kids and young adults is likely confounded. Since the CDC did not demand RCT data showing severe disease reductions at these ages, and rely on observational data, those should be questioned.
4. There is no good data to vaccinate children and boost young adults. This is a crisis of evidence.

But that’s not what they conclude. Let me tell you what they suggest we do:

1. “Primary care physicians who wish to help patients avoid becoming traffic statistics, for example, could take the opportunity to stress standard safety reminders such as wearing a seatbelt, obeying speed limits, and never driving drunk”

This is ridiculous. The authors have no evidence that this intervention will help, and in particularly, that it works preferentially in unvaccinated (i.e. why not just tell everyone). They are making things up, and that is shameful.

2. “The observed risks might also justify changes to driver insurance policies in the future.”

This one is just plain sad. They want to leverage this information to discriminate yet again against unvaccinated without evidence or understanding that this discrimination may even further vaccinate hesitance and create more animosity to authority. 

Overall, the paper has one useful fact in it. Vaccinated people are different, and that is why we need RCTs to support perpetual boosters and cannot rely on observational data, but the authors are so misguided— they instead cling to their worldview, and would have us tell unvaccinated people to drive slow, and, by the way, let me raise your insurance rates.

Their recommendations are very likely futile, discriminatory and harmful. They are so convinced of their worldview (vax good, unvax’d are scum), they miss the facts in front of their own eyes. 

Unvaccinated people are not a monolith— and some are likely even making a correct decision (young, healthy person who had covid! Why vax?)— papers like this reflect a failure of medicine to focus on what matters.

We wanted unvaccinated older people to get vaccinated in first half of 2021. Everything else was trivial. Boosting teenage boys and vaccinating babies has no RCT data, and observational studies will be confounded, and only a misguided person would pursue those policies. 

Unfortunately, many of those people work for this White House.

Republished via the author’s Substack

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Anyone who has followed Twitter news over the last month has to conclude the news is biased towards the negative. Nearly every headline I read is critical. For a while, pundits predicted the entire website would crash; Spoiler alert, it did no such thing.

Before Elon took over the company, it was losing money. Naturally, to turn losses into profits, someone would have to take quick and swift action. I’m personally not surprised that action includes cutting jobs, eliminating benefits (such as free lunch), devising novel ways to make money (Twitter blue), and other changes. This is to be expected if you have to rapidly turn something not profitable into something profitable.

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Strangely, at every turn, every action of the company is portrayed in the most negative light. Many were upset that for $8 a month people could create a fake Eli Lilly account and talk about the price of insulin. Who cares? Was it so bad? The fake account drew attention to a real problem: the unsustainable price of insulin. The bigger problem is that drug companies make trivial modifications to the insulin molecule, to ensure exclusivity. And doctors do not demand good evidence to switch to the novel formulations, many greased with financial conflicts of interest. That was less well appreciated. 

Many pundits argue that Twitter staff has been cut too thin. They are argue that the website would come crashing down. That never happened. It also seems to betray a deep ignorance of what a website is. This is not an assembly line making widgets. It’s a digital tool. Elon has a thousand engineers left. He also has the ability to contract any amount of work he wants. Millions of people have the skill set to code in this space. Why are they so worried the website’s going to fail? It seems bizarre. It doesn’t take much to keep it going.

Also, it is probably the case that Twitter did grow too fast, and many people who work there are not absolutely vital to the functioning of the company. That’s true in most large organizations. Why wouldn’t that be true here?

Overall, the news coverage is extremely pessimistic, almost rooting for failure, or trying to create the failure itself. If you ask me it all boils down to one thing:

The legacy media is staffed with people, mostly left of center, who have enjoyed the current content moderation which favors left of center viewpoints, and discriminates against right of center viewpoints. They are worried that Elon is going to level the playing field, and they don’t want that. As such, they’re happy to see him fail, and they will do anything in their power to ensure that failure. Including trying to sabotage advertisements, and create the narrative that the company is on the brink of collapse. 

I’m also left of center, but I agree with the classically liberal principle that you have to allow speech to progress largely unfettered. As such, I think, Elon has the right vision.

If I were to fault the journalism on this topic it would be in two dimensions. One, this is actually not that important a news story so their coverage of it is disproportional to its importance. Two, they just have a narrative they’ve constructed in their head, and they may or may not fully understand that the real motivation, but they are blindly chasing that narrative and ignoring any data that doesn’t fit it. As such it is biased. 

Unfortunately for them, Elon has a lot in his favor. The remaining workers are likely tremendous. The website is benefiting from free advertisement. It is still very easy to use. (Not like Mastodon). And it won’t take much to keep it going. A year from now It’s going to be a lot stronger than it is today. Someday Twitter will just be another company that Elon turned around.

Article republished from the author’s Substack.

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On Thursday, the CDC’s advisory committee on vaccines voted unanimously—15 to 0—to add the Covid-19 vaccine to the country’s childhood immunization schedule. 

This schedule of vaccines—which includes the vaccines for measles, mumps and rubella (MMR); tetanus, diphtheria, pertussis (Tdap); and inactivated polio—serves as the roadmap of routinely recommended vaccines for children across the nation. That’s among the many reasons the committee’s vote is consequential: State and local governments turn to the CDC’s guidance when deciding public health policy. The CDC has yet to adopt this guidance, but likely will in the coming weeks.

I believe it was both bad medicine and bad policy to add the Covid-19 vaccine to this list. I come to that conclusion for four reasons:

1. Parents are frustrated with the CDC and its Covid-19 guidance. And for very good reason. During the pandemic, many parents believed that CDC recommendations—on quarantine, for instance—resulted in local officials locking kids out of school for too long or unnecessarily, which resulted in devastating learning loss. But when those parents complained to the schools, education officials said they were simply following CDC recommendations. So now, while the CDC may be technically correct that inclusion of the Covid-19 vaccine on the immunization schedule is not a mandate, it feels to many parents like more buck-passing from this influential agency.

Covid-19 and the question of when—if ever—to vaccinate kids has become among the most politicized topics in the country. Many municipalities, private schools, and day care centers in left-leaning areas will see the CDC’s imprimatur as an opportunity to institute mandates.

Mandates are concerning for two reasons. First, it is not clear they are ethical. The standard rule in medicine is simple: We do not intrude upon individual autonomy unless that intervention provides sufficient benefit to third parties. This means there must be a large benefit to others— enough so the loss of autonomy is acceptable. Given that the Covid-19 vaccine does not halt virus transmission, the prerequisite is not met. 

The second reason is that mandates will harm vulnerable kids. As of July, the Kaiser Family Foundation found that in several states, black and Hispanic children under 12 years old were less likely to be vaccinated than white children, as the chart below illustrates:

If mandates become the norm, unvaccinated children will be displaced to virtual school, home school, or perhaps no school at all. The harm to kids from substandard education—after nearly two years of disruption—far exceeds any gains from compliance. And that harm will disproportionately hurt poor, black kids. The same is true for mandates that prevent kids from participating in school sports. Being sedentary is far more damaging for children’s health than not getting this shot.

2. The CDC’s gamble could very well hurt vaccination rates more generally. In an effort to encourage Covid-19 vaccination, the CDC may wind up lowering vaccination rates for polio and measles. Why? Because by adding Covid-19 shots to the schedule, the CDC is tacitly implying that this new vaccine is as important to kids as the combination MMR one. This is absolutely false. 

Measles can be a devastating childhood illness, but vaccination provides durable, sterilizing immunity. When vaccination rates are high, measles outbreaks can be averted. Covid-19 vaccines, as millions have learned, do not prevent you from getting Covid-19. Right now the CDC director Rochelle Walensky has Covid, despite being boosted with the bivalent booster just one month ago.

Covid vaccines do work to lower the risk of severe disease. But for healthy kids, the risk of severe disease is already extremely low. Once a child recovers from Covid, having had the disease itself provides immunity equivalent to—or perhaps better than—the vaccine. Currently, the CDC estimates that at least 86 percent of American children have had Covid. For this reason, I, along with policy makers in many advanced nations, think it is reasonable for a parent to vaccinate their child against Covid, and also reasonable not to.  

One of the worst outcomes of the CDC Covid-19 vaccination recommendation would be if parents decide it is unnecessary for their children to get the Covid shot, they will also skip vital vaccines that have been saving lives for decades.  

3. The U.S. is profoundly out of step with peer nations. For example, Denmark has ceased to offer vaccination in healthy kids under the age of 18, and does so only when deemed medically necessary.  That’s because kids very rarely become seriously ill with Omicron. Sweden has just abandoned its recommendation for vaccinating healthy children above the age of 12 (it had never recommended vaccination for kids 5 to 11), and will only vaccinate children with medical problems. In making their new recommendation, the CDC fails to acknowledge the legitimate debate about what is best for children among our peer nations. (For males aged 10 to 40 myocarditiscaused by the vaccine is an important safety concern. But this appears less common in younger children, and is not an issue for the childhood vaccination guidelines).

4. The CDC is also at odds with parents’ preferences. Data presented by the CDC show that only 6.9 percent of kids between the ages of six months and four years old have gotten even a single dose of the vaccine. Just 38.6 percent of kids between 5 and 11 have gotten one dose. Most parents have chosen not to give the Covid-19 vaccination to their kids. The CDC’s endorsement further puts the public health establishment not just out of step with other nations, but with most American parents. This risks deepening the lack of trust and authority in the agency. 

To this day, the CDC advises Americans who were exposed to Covid to wear a mask in their own home for 10 days around others. It’s no wonder that the CDC has badly lost credibility with many Americans.

In 1998, the Lancet published a deeply flawed study that should never have appeared claiming vaccines were linked to autism.  Eventually it was found to be fraudulent. Nevertheless, parents and activists ran wild with it. It has taken decades to fight the false connection between vaccines and autism—and it is still a battle not fully won. We need the public to believe in medically essential vaccines and be willing to give them to their children. To add an unnecessary and controversial vaccine to this list—at the risk of some states or local actors mandating it—undermines the broader good of public health.