Portal de Periódicos da CAPES

Healing Words

2022; Lippincott Williams & Wilkins; Volume: 44; Issue: 4 Linguagem: Inglês

10.1097/01.eem.0000827720.23407.5a

1552-3624

Mark Mosley,

Empathy and Medical Education

Figure: medical ethics, misinformation, pseudoscienceFigureTruth is another casualty of plague. —Nicholas A. Christakis, MD, PhD, Apollo's Arrow: The Profound and Enduring Impact of Coronavirus on the Way We Live We physicians have been shamed by a science fiction narrative advertised electronically as breaking medical news, and it has plagued our American village. Some of this information is pseudoscience, but some of it is not, which makes the vivisection of fact murkier and stormier. Some medical informants do not have diabolical intent. They have reasonably said, “What is the harm of trying x if it doesn't hurt you and it might help?” One answer to this seemingly common-sense approach is that you lose scientific integrity, the proper process of the scientific method upon which modern medicine has established a trustworthy foundation. If we allow a physician to use his professional degree as a flag of his personal therapeutic experiences and beliefs, we all lose the battle of truth and trust regardless of intent. This rush to treat with little more than anecdotal information and raw studies is even more damning now that we have validated prevention with vaccines and proven treatments with pharmaceuticals. Now we have patients who won't get a vaccine, though it has been proven in more than four billion people, but they will take ivermectin bought at a feed store because their primary care doctor or an “expert” found on Facebook said, “Why not?” The contemporary American physician risks a de-evolution into preprofessional late 19th century medicine show entertainer (e.g., Dr. Oz). Trust is mesmerized and massaged by emotional appeal or political conspiracy. My Kansas medical community, which has historically been a bastion of solid, respected physicians, now has practitioners who, like Dr. Frankenstein, seem scientifically Promethean as they go through the village promoting their discovery that operates out of a different brain. We have PCPs and their minions giving IV vitamin C, ivermectin, vitamin D supplements, zinc tablets, and azithromycin with steroids for everything COVID-19. (References against these therapeutics can be found in my article, “The Drivers of COVID-19 History,” EMN. 2021;43[12]:26; https://bit.ly/3Dc0LN1.) We have physicians on school advisory panels recommending that masks should never be required among K-12 students. Some OB/Gyns have even told their OB patients not to get vaccinated. A pathophysiology has evolved for creating untruth. There is a vigilantism and beastly exhilaration in enjoying the disfigurement of traditional medical institutions and approaches. It is as if the year 2020 unleashed a monster that has made everyone go scientifically mad! Recommit to Ethics It is time to reign in our untethered colleagues and shout above the maniacal mob that much of the COVID-19 news by “medical experts” is poor science. Bags of reports are dug up from dirt daily and shocked into a life of deformity. Medical news has been animated into a capitalized product of media businesses rather than preliminary data that await thoughtful dissection by science-based communities. Medical education and physician organizations must recommit to an ethical climate change to create professionals who have their head on straight. Statistically-supported medicine is rarely flashy—it is mostly slow, tedious, and boring, not the current lightning-charged medical information meant to alarm and amaze. The smell of electrified and burned experimental flesh is so pungent that we lose taste and smell to any thoughtful science around us. Allow me to move this appeal from a colorful storied argument to rather bland non-fiction examples regarding some black-and-white numbers (all before Omicron). Up to 50 percent of all COVID-19 transmissions are asymptomatic or presymptomatic. (Proc Natl Acad Sci U S A. 2020:117[30]:17513; https://bit.ly/3swRzQ3.) This is the impetus for wearing a mask (now preferably surgical or respirator) and physically distancing during periods of significant prevalence. Decreased transmission of COVID-19 in the real world among American children K-12 using cloth masks is an absolute decrease of 18.5 cases/100,000 a day (35 cases in nonmasked v. 16 cases in masked per 100,000 a day). (MMWR Morb Mortal Wkly Rep. 2021:70[39]:1377; https://bit.ly/3oFE27I.) These studies used predominantly cloth masks of various styles and characteristics among a population that one could argue may have had various confounding by improper compliance. Surgical masks in a community setting in a large randomized controlled trial among 350,000 Indonesian villagers showed an absolute difference of one percent (8.6% v. 7.6%) and a relative difference of 11 percent during a time of low incidence with no significant difference in cloth v. no mask. (Science. 2022;375[6577]:eabi9069.) Surgical masks in the subset of those over age 60 made a relative difference of 35 percent in infection. Myocarditis and pericarditis from COVID-19 infection was 11/100,000 and from the vaccine was 2.7/100,000 with an absolute difference of 8/100,000. (N Engl J Med. 2021;385[12]:1078; https://bit.ly/3Lt03QL; JAMA Cardiol. 2021;6[10]:1202; https://bit.ly/3uHJvyC.) No serious outcomes occurred in the vaccinated group, but the numbers were underpowered to draw statistical comparison on severity of illness. Profit, Votes, Fame IV monoclonal infusion (bamlanivimab-etesevimab) resulted in a five percent absolute difference in hospitalizations, and was performed in high-risk outpatients within three days of lab-confirmed COVID-19 (2.1% v. 7% in placebo group). (N Engl J Med. 2021;385[15]:1382; https://bit.ly/3GLTtkJ.) Death was reported together with hospitalizations and was different with 11/518 in monoclonal therapy and 36/517 in the placebo group, but this 11 v. 36 is underpowered to draw independent conclusions. Oral (antiviral) molnupiravir resulted in a three percent absolute difference in hospitalization of 48/709 v. 69/699 in the placebo group in a randomized placebo-controlled trial, double-blinded among high-risk unvaccinated patients with mild to moderate symptoms where hospitalization was a surrogate marker for disease progression. (N Engl J Med. 2022;386[6]:509; https://bit.ly/3rxwdkS.) Subgroup analysis revealed more hospitalizations in diabetics and those with previous COVID (unclear if the vaccinated would parallel a previous COVID subgroup). A booster along with two Pfizer vaccines decreased infection by about five percent compared with two Pfizer vaccines alone (6.6% v. 1.8%) and decreased mortality (0.16/100,000/day=65 deaths v. 2.98/100,000/day=137 deaths). (JAMA Intern Med. 2022;182[2]:179; N Engl J Med. 2021;385[276]:2413; https://bit.ly/3uH6ObY.) Among this extremely brief sampling of recent COVID-19 data, one should be struck by the small amount of absolute difference found among interventions that could be wrongly interpreted as not making much difference. Recall that a one percent absolute difference in mortality among large numbers, say eight million, could make the difference in 800,000 lives! The other point that should be reiterated is that these studies are specific to unique cultures and populations at a given time, to say nothing of biases inherent in the type of study. These studies have multiple layers of complexity and potential confounding deserving of many statistical points-counterpoints among scientific experts skilled in the interpretation of statistics. In other words, no one should walk away after reading the conclusion of one of these studies and give a quick thumbs up or down on its implementation, to say nothing of posts you click on using your phone. Only companies, political parties, and mad professors clamoring for profit, votes, or fame talk with that kind of brash certitude. The medical professionals with cooler statistical heads need to police this information, walk out of this storm into the light, and tell the frenzied citizens to go home as we work to prevent the Dr. Frankensteins among us from destroying us with monstrous approaches toward medical science. There is no greater honor than to be trusted. We must uniformly bring principled and normative medical science back to life. Dr. Mosleyis an emergency physician in Wichita, KA.