First, a wise person messaged me to say with a fishing expedition like this, they should adjust for multiple hypothesis testing, by doing so, some of the benefits & harms will vanish, as chance variation. Good point!
Second, Alasdair Munro nicely points out the magnitude of the mental health gain:
"Why are we focussing on the tiny 9 per 100,000 person year increased risk of clots, surely we should be more interested in the massive 1500 per 100,000 person year REDUCTION in anxiety disorder!
🚨Covid is good for your mental health!*
*sarcasm"
Ha! he is right
Third, some argue that newborn kids should still get COVID vaccination b/c they would not have yet had covid. This study of course is unable to comment on that. I am not aware of any study that would pertain to (presumably 6 month olds-- who are first eligible for COVID Wuhan-strain vax in 2023) as to whether they will benefit against the new circulating strains that arise with respect to hospitalization, death, or other clinical endpoint. I look forward to seeing that trial! If positive for clinical outcomes, absolutely! If negative, nope. Since nearly no parents are getting the vax for 6 months old (<5% in USA), and since these are select people, obs studies will again be useless, plagued with confounding.
I am not buying that claims based data and Diagnosis codes are accurate. When I order a test using Epic or an EHR it requires a CPT code before the test is scheduled. These codes accrue in the medical record. And their presence does not reflect the real diagnosis but rather the billing practice. It’s sorta upcoding. So using database codes without verifying the diagnosis is a really inaccurate way to define an outcome.
I have not pulled this MMWR yet to review it but I would bet this is a Kaiser based study. They have been cranking out crappy epi science all pandemic long.
Finally MMWRs are not peer reviewed, they undergo internal review to determine if the study comports with current CDC policy.
So they can put time and money into whatever this is, but still no interest into looking into whether 1-dose might be acceptable and safer for teen boys to satisfy vaccine requirements, like Pfizer themselves said it might be?
Every day, I mute Twitter accounts (possibly real people and also bots) that are too alarmist for my personal tolerance, and I just muted some doctor who tweeted about this study.
How will we ever trust our institutions and even our own physicians again? It is very discouraging. I’m sure many have reached a point where they are no longer comfortable trusting our basic health needs to the physicians we deal with regularly. I’m thinking it’s not good on so many levels. Makes me sad.
You highlighted the mental health paradox but not the most damning part of all. Covid patients are less likely to have respiratory post viral sequelae?! This is by far the most common "long covid" symptom. Cough frequently can linger for weeks-months. Clearly they are not comparing apples to apples.
Vinay, I am enjoying watching you be red-pilled on the horror of the government. Over the years I have come to believe that these people are not just stupid, but are actually evil in that their only purpose is to comport to the (generally left wing) narrative-du-jour rather than to any science.
I believe public health is beyond rescue in the American mind -- and I have come to believe it should be. My biggest worry, expressed here since you started writing, is the spillover to non-public health practitioners. The pediatricians are the worst and I get more calls from parents questioning the blather they keep spouting than from any other group. But no one intelligent is believing most anything that the medical community says today and, sadly, one can understand why.
There just is not bandwidth to explain everything one concludes about a patient during a visit -- four years of college, four of medical school, four of residency and two of fellowship, followed by 30 of practice, cannot be encapsulated in three minutes. But patients are losing trust in this essence of the physician-patient interaction because they have (with cause) come to believe that many doctors are just parroting the official line without understanding the facts (as so well explained in your article today) and without considering the individual patient's relationship to those facts.
We will likely not repair this during my lifetime which makes me very sad -- I have spent my entire life patient by patient, not government directive by government directive, but patients have been burned and will be a long time recovering.
Thanks for your strident take on this all. As another point (you still need a copy editor) in the final sentence "of" should be "off" -- powerful line, though.
I signed up for your Substack after looking at some of your Youtube covid videos, particularly the Annals vs MMWR studies on long COVID. I'm hoping you continue to follow and make updates on long COVID in adults. I have friends who are scared to death of long COVID based on following Twitter threads about the huge incidence, and T-cell exhaustion, and, and....
The main thing I took away from my training in biostatistics and study design is that humans don't intuitively grasp the category difference between observed correlations vs prospectively gathered controlled data. They have to learn this. Congrats on being the full professor who can now focus his abundant energy on this task!
This bears repeating- “ But worst of all is just how bad many doctors are at doing science, reading science, and making scientific arguments.” I left my PCP after 22 years because he told me that masks work. His evidence? Since the practice instituted mask mandates, they didn’t have any flu. He was so convinced, he wanted to make masking permanent. Never mind that they also instituted a policy of not allowing anyone with any cold symptom at all inside the building. (Those patients are seen outside, in the parking lot.) Never mind that there was no flu anywhere. My PCP is very intelligent, graduated from elite schools, but a child could do better science than this!
Started dating someone recently. I really like her. It was a huge relief to find out she's very alt-middle: believes vaccines should be for the vulnerable, didn't vaccine her young and healthy children, and only wears a mask when it's required.
You wouldn't believe how many dating app profiles (here in the Los Angeles area) have "vaccinated" or "triple vaxxed" or "swipe left if you're unvaccinated."
Three updates to this piece:
First, a wise person messaged me to say with a fishing expedition like this, they should adjust for multiple hypothesis testing, by doing so, some of the benefits & harms will vanish, as chance variation. Good point!
Second, Alasdair Munro nicely points out the magnitude of the mental health gain:
"Why are we focussing on the tiny 9 per 100,000 person year increased risk of clots, surely we should be more interested in the massive 1500 per 100,000 person year REDUCTION in anxiety disorder!
🚨Covid is good for your mental health!*
*sarcasm"
Ha! he is right
Third, some argue that newborn kids should still get COVID vaccination b/c they would not have yet had covid. This study of course is unable to comment on that. I am not aware of any study that would pertain to (presumably 6 month olds-- who are first eligible for COVID Wuhan-strain vax in 2023) as to whether they will benefit against the new circulating strains that arise with respect to hospitalization, death, or other clinical endpoint. I look forward to seeing that trial! If positive for clinical outcomes, absolutely! If negative, nope. Since nearly no parents are getting the vax for 6 months old (<5% in USA), and since these are select people, obs studies will again be useless, plagued with confounding.
At *SOME* point, this clown show has to stop, right? RIGHT? Dear GOD, please say yes!
I am not buying that claims based data and Diagnosis codes are accurate. When I order a test using Epic or an EHR it requires a CPT code before the test is scheduled. These codes accrue in the medical record. And their presence does not reflect the real diagnosis but rather the billing practice. It’s sorta upcoding. So using database codes without verifying the diagnosis is a really inaccurate way to define an outcome.
I have not pulled this MMWR yet to review it but I would bet this is a Kaiser based study. They have been cranking out crappy epi science all pandemic long.
Finally MMWRs are not peer reviewed, they undergo internal review to determine if the study comports with current CDC policy.
You are one of the few doctors I trust. Thank you for providing perspective in these matters!
So they can put time and money into whatever this is, but still no interest into looking into whether 1-dose might be acceptable and safer for teen boys to satisfy vaccine requirements, like Pfizer themselves said it might be?
Every day, I mute Twitter accounts (possibly real people and also bots) that are too alarmist for my personal tolerance, and I just muted some doctor who tweeted about this study.
How will we ever trust our institutions and even our own physicians again? It is very discouraging. I’m sure many have reached a point where they are no longer comfortable trusting our basic health needs to the physicians we deal with regularly. I’m thinking it’s not good on so many levels. Makes me sad.
You highlighted the mental health paradox but not the most damning part of all. Covid patients are less likely to have respiratory post viral sequelae?! This is by far the most common "long covid" symptom. Cough frequently can linger for weeks-months. Clearly they are not comparing apples to apples.
Vinay, I am enjoying watching you be red-pilled on the horror of the government. Over the years I have come to believe that these people are not just stupid, but are actually evil in that their only purpose is to comport to the (generally left wing) narrative-du-jour rather than to any science.
I believe public health is beyond rescue in the American mind -- and I have come to believe it should be. My biggest worry, expressed here since you started writing, is the spillover to non-public health practitioners. The pediatricians are the worst and I get more calls from parents questioning the blather they keep spouting than from any other group. But no one intelligent is believing most anything that the medical community says today and, sadly, one can understand why.
There just is not bandwidth to explain everything one concludes about a patient during a visit -- four years of college, four of medical school, four of residency and two of fellowship, followed by 30 of practice, cannot be encapsulated in three minutes. But patients are losing trust in this essence of the physician-patient interaction because they have (with cause) come to believe that many doctors are just parroting the official line without understanding the facts (as so well explained in your article today) and without considering the individual patient's relationship to those facts.
We will likely not repair this during my lifetime which makes me very sad -- I have spent my entire life patient by patient, not government directive by government directive, but patients have been burned and will be a long time recovering.
Thanks for your strident take on this all. As another point (you still need a copy editor) in the final sentence "of" should be "off" -- powerful line, though.
I admire your prodigous energy!
I signed up for your Substack after looking at some of your Youtube covid videos, particularly the Annals vs MMWR studies on long COVID. I'm hoping you continue to follow and make updates on long COVID in adults. I have friends who are scared to death of long COVID based on following Twitter threads about the huge incidence, and T-cell exhaustion, and, and....
The main thing I took away from my training in biostatistics and study design is that humans don't intuitively grasp the category difference between observed correlations vs prospectively gathered controlled data. They have to learn this. Congrats on being the full professor who can now focus his abundant energy on this task!
This bears repeating- “ But worst of all is just how bad many doctors are at doing science, reading science, and making scientific arguments.” I left my PCP after 22 years because he told me that masks work. His evidence? Since the practice instituted mask mandates, they didn’t have any flu. He was so convinced, he wanted to make masking permanent. Never mind that they also instituted a policy of not allowing anyone with any cold symptom at all inside the building. (Those patients are seen outside, in the parking lot.) Never mind that there was no flu anywhere. My PCP is very intelligent, graduated from elite schools, but a child could do better science than this!
Started dating someone recently. I really like her. It was a huge relief to find out she's very alt-middle: believes vaccines should be for the vulnerable, didn't vaccine her young and healthy children, and only wears a mask when it's required.
You wouldn't believe how many dating app profiles (here in the Los Angeles area) have "vaccinated" or "triple vaxxed" or "swipe left if you're unvaccinated."