VAERS is a voluntary collection network that is prone to two types of biases. First, it may undercount vaccine-related events because providers did not recognise them or lacked motivation to report them. But it can also overcount them. Bad things can happen after vaccination, such as heart attack, that are entirely coincidental but that still might be reported.
Trying to find safety signals due to vaccination requires comparison against base rates, or how many events are expected to occur without vaccination. Even very unusual events, such as the blood clots that happened after the Johnson & Johnson vaccine, stand out fast. Similarly, elevated myocarditis rates in young men, especially after dose two of Moderna, jump out of the data.
Death signals are trickier to parse, and require knowledge of the ages and medical problems of people getting vaccinated. Even then, they must be weighed against data that shows vaccines reduce a big cause of death — death from Covid-19. For these reasons, I think it is premature and misleading to talk suggest that the vaccine caused 45,000 deaths. If McCullough wishes to make this case, the best forum would a scholarly publication, where other researchers can examine and critique his methodology.
Claim: US vaccine policy ignores the science on natural immunity
Malone and McCullough both make valid points that vaccine policy has not accommodated scientific knowledge of natural immunity. Should vaccines be required for people who have already been infected with Covid? If a healthy young person had one dose of the vaccine and then got Omicron, do they need a second? What if a person had two doses and Omicron — should they need to receive a booster, as some workplaces now require? These are open and legitimate questions.
Proponents of vaccines and boosters for those with a prior Covid-19 infection often point to antibody titers — blood tests showing that a recently vaccinated or boosted person has higher levels of Covid-19 antibodies than someone with natural immunity. But this is not persuasive.
Antibodies are a means to a clinical end, which is preventing someone from getting re-infected, becoming very sick, becoming hospitalised, or dying. Antibodies, especially in the short term, are bound to be higher the more you dose an individual, but the scientific burden is to show that these doses further improve the clinical endpoint in randomised studies. This burden has not yet been met.
Yet, here too, Malone goes over the top. He and Rogan refer to “multiple studies” showing that those who get vaccinated after being infected with Covid are at a two-to four-times greater risk of having an adverse reaction to the vaccine; later, Malone describes Rogan’s friends who are encouraging him to get vaccinated as asking Rogan to put himself “at higher risk” and “take more risk for your health in order to join their club”. There is a dialogue to be had about whether Rogan might benefit from zero, one, or two doses, but the overall risks of vaccination remain low, particularly for a 54-year-old man such as Rogan.
At times, Malone refers to accurate studies, but I worry the audience draws the wrong inference. Malone, for instance, claims that natural immunity is six to 13 times more effective than the vaccine at preventing hospitalisation and 27 times more effective against developing symptomatic disease. I assume he is referring to this August 2021 study from Israel. This study does indeed suggest that natural immunity is more protective than vaccines against the Delta variant, though it also suggests that natural immunity plus a single vaccine dose is more protective than natural immunity alone.
While this has implications for the number of doses a Covid-19 survivor might consider getting, it should not be misconstrued to mean that infection is preferable to vaccination for an adult who has yet to experience either. Vaccination is almost surely preferable for most un-immune adults.
At one point in his interview, Malone says: “Think twice about giving these jabs to your kids.” While I can understand how many will be angered by this statement, the truth is other nations, such as the United Kingdom, are thinking twice — at least for healthy 5 to 11-year-olds, the group with the lowest risk of bad outcomes from Covid. As of this moment, the UK’s advisory panel has said that only 5 to 11-year-olds with comorbidities should get vaccinated.
Claim: Effective early treatments, including hydroxychloroquine and ivermectin, are being suppressed
McCullough and Malone are proponents of early treatment for Covid-19, specifically with ivermectin and hydroxychloroquine. Both allege that public health authorities have intentionally suppressed the use of these drugs. McCullough states that early in the pandemic, “there was no focus on sick patients”, while Malone speculates that hospitals don’t want early treatments because they profit when people are hospitalised and claims that “probably half a million excess deaths” have happened in the United States through the intentional blockade of early treatments.
These are entirely false and insulting allegations, and Malone’s in particular are flat-out conspiratorial. Academic hospitals attempted all sorts of disparate treatment protocols in the hopes of helping sick patients. Many physicians did not wait for randomised control trials — the gold standard of medicine — to act; they simply acted. In fact, a Harvard hospital recommended hydroxychloroquine prior to randomised data.
The problem was not that there was no appetite for early treatment. The problem was that when the randomised trial data came in, they suggested the drugs favored by Malone and McCullough were ineffective. A pooled analysis of all such studies by Axfors and colleagues suggests patients treated with chloroquine and hydroxychloroquine had increased risk of death.
And ivermectin has not shown persuasive evidence of benefit in randomised trials to date. Of course, a randomised trial cannot prove that a therapy can never work under any circumstances, just as you cannot prove that Santa Claus doesn’t exist. But the burden is on proponents to show when and how their therapy helps, and they have not met it.
Rogan, Malone and McCullough are wrong to claim that ivermectin and hydroxychloroquine are known to be secretly effective, but they are correct that these drugs have been unfairly demonised. The truth is that they are neither particularly dangerous nor effective. The media labelling ivermectin a “horse drug” or “horse dewormer” was particularly absurd. Ivermectin is a well-known drug taken by humans all over the world.
Claim: Public debate over Covid-19 is often unfairly censored
Malone, Rogan, and McCullough are all correct on one topic: there is an effort to suppress information and censor debate on social media. The clearest example is that for more than a year, Facebook banned all discussion of the lab-leak hypothesis, until articles by Nicholson Baker, Nicholas Wade, and Donald McNeil broke the dam. This was a remarkable suppression of free speech.
Previously, I investigated the mechanism by which Facebook polices pandemic “misinformation” through third-party investigators. I found, in several cases, that the expert designated to fact-check a claim had already stated their opinion on it prior to being selected. This is a deeply problematic mechanism, as the person who selects the fact-checkers can scour the Internet to an expert who agrees with them, and there is no external review, appeal or oversight.
Malone discusses a controversial October 2020 email from National Institutes of Health director Francis Collins to Anthony Fauci in response to the Great Barrington Declaration. In it, Collins called three of the declaration’s authors “fringe” epidemiologists and demanded a “quick and devastating published take down of its premises”. I completely agree this was problematic.
As I have argued elsewhere, 2020 was a time of deep uncertainty about the science surrounding Covid-19 and the appropriate policy response to the pandemic. Collins is not an epidemiologist, and he has no standing to decide what counts as a “fringe” view within that field. As NIH director, his job is to foster dialogue among scientists and acknowledge uncertainty. Instead, he attempted to suppress legitimate debate with petty, ad hominem attacks.
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The efforts to censor Malone and McCullough have massively backfired, with both men gaining prominence and publicity from the attempts to shut down their speech. More generally, I strongly disagree with efforts to censor scientists, even if they are incorrect, and no matter the implications of their words, as I believe the harms of censorship far exceed any short-term gains.
One problem, which has been on full display in this controversy, is that censorship may draw more attention to incorrect ideas. Another is that in the middle of any crisis, the answers to many scientific and policy questions will be uncertain. Disagreement on these questions is natural, and attempts to suffocate “harmful” speech run the risk of stifling critical debates, including by silencing third parties who may have important contributions but who fear the professional or reputational consequences of speaking up.
Perhaps the most serious objection to censorship is that the censors themselves are not fit for the task. Censors are unaccountable. They may be biased, misinformed or undereducated. They may lack perspective. In short, they are as fallible as the people they are trying censor. This is especially true in science, where, as history shows us, consensus views can turn out to be false, while controversial or heretical ideas can be vindicated.
Finally, in the modern world, where the censor is so often a giant technology company, there is tremendous potential for abuse. The same tools used to suppress scientific “misinformation” may someday be used to solidify political power and stifle dissent.
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