Pricey Dr. Vinay Prasad,
I knew you earlier than COVID. Such as you, I’m a practising medical oncologist. I first found your identify years in the past after I stumbled upon your oncology podcast. Afterward, I proudly transformed to Medical Conservativism after embracing your mission assertion: The Case for Being a Medical Conservative. I’ve learn your e book as nicely. We’ve by no means truly met, however I’ve been following you throughout varied media codecs for a very long time. Throughout my journey, I’ve been repeatedly in awe of your means to critically appraise the oncology medical literature. The strategies that I’ve discovered from you proceed to tell the best way that I consider new information and train my medical college students.
Whereas listening to you shred (a praise) the newest oncology journal article in your podcast, I’ve usually discovered myself questioning the way you follow drugs in your most cancers clinic. With maybe one exception, I’ve but to listen to you whole-heartedly endorse a accomplished medical research. As a substitute, you’re fast to level out methodologic flaws and second-guess the newest FDA approvals. If I took each phrase actually, I’d predict that you don’t prescribe any of the most cancers therapies that you’ve got beforehand eviscerated in your podcast. However, I do know that’s not actuality.
I acknowledge your model of frenetic bluster – you’re a contrarian. Contrarians are wanted. In my oncology follow, I’m inundated with pharmaceutical salespeople and e mail ads selling the newest oncology drugs (with new value tags upwards of $200,000 per 12 months). You appropriately level out when there may be solely a marginal profit to be obtained at very excessive societal price. I discover worth in questioning the established order, even when it is just whereas listening to your weekly 30-minute podcast on my drive dwelling. Listening to a contrarian viewpoint from time to time doesn’t paralyze me. In reality, I consider it makes me a extra well-rounded doctor. My oncology sufferers proceed to obtain the newest therapies even when the underlying research is partially flawed. I’m positive that you simply deal with your sufferers equally.
Extra lately, I’ve watched you apply your model of flippant contrarianism to COVID. On account of your new content material and continued flare for supply, your viewers has grown nicely past the smaller world of medical oncology. You’ve got absolutely seen that your new viewers is now extra more likely to be politically motivated than medically oriented. Because of this, they is probably not correctly geared up to position your indignation inside the broader scope of conventional medical opinion. For them, the script is probably going flipped, with the contrarian viewpoint changing the usual of care.
When you would possibly see that as a constructive, I fear that listening to primarily contrarian viewpoints might be paralyzing. How else does one clarify the decreased COVID vaccine uptake within the Purple States? I respect the flexibility of my sufferers to make knowledgeable selections in my dwelling state of Alabama. Nevertheless, when that call course of is cross-pollinated by politics my confidence wanes. By not totally recognizing how your viewers has modified, I concern that you might have unintentionally contributed in some small method to these worse outcomes. Fortunately, there may be nonetheless time to recalibrate your messaging for the following slate of public well being selections.
As I write this, your affect is at a brand new excessive and the long run looms massive. Your pals are accepting vital authorities positions. You might be doubtless fielding some flattering and influential employment provides as nicely. Whether or not you modify jobs or not, please acknowledge that you’re now influencing the nationwide public well being coverage. Your function within the public sq. has developed in a big approach, whether or not you meant this or not. I hope you perceive that being in authority is a really totally different job than merely questioning authority. You not have the posh of being the bombastic underdog contrarian; your viewers is just too massive and the stakes are too excessive.
I’m watching with curiosity to see how you’ll reply in your new function. Sadly, the early returns aren’t nice. An article you latterly penned in The Free Press makes an attempt to “draw distinctions” on a mess of potential insurance policies that Robert F. Kennedy, Jr could attempt to implement. You make the reader conscious that some of RFK Jr’s controversial suggestions are at the moment applied in different nations. On informal inspection of the article, I don’t see any overt factual areas. You appropriately level out that “all European nations suggest utilizing MMR vaccines in kids” and precisely state that “no nation I’m conscious of warns in opposition to utilizing it as a result of it results in autism”.
Later within the article, the bottom will get a bit shakier while you make the seemingly cheap assertion that “vaccines are like medication. We want extra proof.” However, the good thing about vaccines prolong past the straightforward evidence-based calculation of number-needed-to-treat that you simply proselytize. Even in conditions the place the person advantage of vaccination is low, vaccines usually have a further profit – they hold our neighbors wholesome, too. If I resolve to not take a ldl cholesterol drugs, that call solely impacts my danger of stroke and coronary heart illness. However, when somebody declines a vaccine, it raises the danger of an outbreak inside the complete neighborhood. There’s a public, and dare I say, patriotic element to vaccination that makes it very totally different from the most cancers therapies that you simply and I administer in our clinics.
And naturally, we at all times “want extra proof” to tell our medical follow. Such as you, I’m normally in favor of ethically accumulating extra information. Nevertheless, we should proceed to look after our sufferers whereas we wait (indefinitely). As I alluded to above, a scarcity of excellent proof will not be an excuse to be paralyzed and do nothing. The inherent public well being advantage of vaccines additional raises the stakes of inaction. I consider there may be professional purpose to carry every vaccine to a decrease proof customary than the costly and extremely poisonous chemotherapy therapies that we prescribe. After all, you realize all of this already. In “The Case for Being a Medical Conservative”, you checklist vaccines as one of many penultimate examples of high-value care.
I think that you’d counter that your article will not be truly taking a stance on vaccination or any of the opposite controversial subjects. You might proceed to insist that “if different nations are doing it, we must be keen to look into it”. I take situation with that seemingly benign sentiment as nicely, however will let it move in the interim.
In the end, it isn’t the existence of this text that surprises me. What bothers me is that you are the writer. I’ve by no means heard you parrot authorities public coverage with the implicit assumption that if another person is doing it, it may be okay. The place is the in-depth vital evaluation of the proof that you’re so well-known for?
Studying an article like this opens the door for me to query your biases and maybe even your motives. As a result of I used to see you as above politics, I consider this text is beneath you.
Regardless of my ongoing admiration for you within the oncology area, I’m now nervous. Your vaccine communication and your newest article have given me pause. I at all times thought that your superpower was unbiased vital appraisal of the medical proof. I hope you can rapidly rediscover your superpower and put it to accountable use. Maybe it is going to once more lead you again to your evidence-based roots as we confront a way forward for attempting to fact-check Make America Wholesome Once more.
Sincerely,
Jonathan Storey, MD
P.S. Please beware falling sufferer to the human biases that you simply so astutely determine in others. Particularly, I hope that you’re being vigilant to keep away from motivated reasoning within the type of affirmation bias and viewers seize.